Objectives: Only 15% of patients with colorectal liver metastases (CLM) are candidates for curative hepatectomy at time of diagnosis, limited by anatomical location and tumor burden.Ablative therapies may extend this.This study reports a single institution s long-term experience with hepatic cryotherapy for advanced CLM.Methods: Between April 1990 and June 2009, 304 patients were curatively treated with cryotherapy.Survival was estimated by Kaplan-Meier method.Prognostic factors for survivals were determined by using univariate and multivariate analyses.Results: A total of 293 patients were included into analysis.The median number of lesions treated per patient was three (range, 1-13).The median overall survival was 29 (range, 3-220) months.The 1-, 3-, 5-, and 10-year survivals were 87%, 41.8%, 24.2%, and 13.3%, respectively.A total of 161 patients developed intrahepatic recurrences: cryosite (23%); edge recurrence (14%); and within the liver remnant (78%).The median disease-free survival (DFS) was 9 (range, 1-220) months.The 1-, 3-, 5-, and 10-year DFS rates were 37.9%, 17.2%, 13.4%, and 10.8%, respectively.Univariate analysis identified four factors that significantly affect survival: nodepositive primary tumor (p=0.001), preoperative CEA level (p<0.001), number of lesions (p<0.001),and use of neoadjuvant chemotherapy (p<0.001).However, only primary tumor nodal status was independently prognostic (hazards ratio =2.023; 95% confidence interval, 1.444-2.835; p.001).Conclusions: Hepatic cryotherapy seems to be a safe and effective ablative technique for the treatment of colorectal liver metastases and may offer long-term survival in otherwise unresectable disease.