While hepatic resection of colorectal carcinoma, metastatic to the liver, is a suitable and effective treatment, it nevertheless remains applicable only to a highly selective group of patients. Even within this highly selective group of patients only a minority will survive 5 years disease-free indicating the increased sophistication needed to understand the biological factors that control outcome. It is clear that the good results come from biological suitability and not temporal acceleration of the detection process. Appropriate patients after careful selection and sophisticated diagnostic studies should be subjected to exploration and attempted hepatic resection. A preliminary prognostic scoring system has been presented to illustrate the usefulness of this approach.