The systemic therapy of metastatic colon carcinoma and the surgical techniques, especially the resection of liver metastases, have been continuously improved during the last years. With the combination of metastasectomy and sequential use of new chemotherapeutical options, a median survival of 24-30 months can be achieved. The resection of (liver) metastases provides the possibility of being cured for some patients. Therefore, this option should be evaluated in all patients with isolated liver/lung metastases before the start of chemotherapy, or in the case of non-resectable metastases, during systemic therapy. For medical treatment combinations with VEGF or EGFR antibodies showed an increased efficacy. The determination of K-RAS mutation in tumors allows a rational selection of patients who will not benefit (K-RAS mutant) or benefit more (K-RAS wild type) from treatment with EGFR antibodies. Important clinical factors for treatment selection are a potential neoadjuvant treatment aim in non-resectable metastases, tumor symptoms requiring tumor shrinkage and comorbidities of the patient.