Systemic chemotherapy (CTx) is increasingly used before surgery for colorectal liver metastases (CRC-LM). However, CTx may cause liver injury like steatosis, steatohepatitis and sinusoidal injury which may be associated with postoperative morbidity. Some recent data have even shown an increased mortality in patients with CTx-associated steatohepatitis. We, therefore, analyzed our recent experience with potential hepatic injury and its association with CTx and morbidity in patients undergoing surgery for CRC-LM. Methods: From 2001 to 2007 179 patients underwent primary liver resection for CRC-LM. Sufficient non-tumorous liver parenchyma could be re-evaluated for this study in 102 patients. In these 102 patients (66% male, median age 62 years, median BMI 26, 8% diabetes (IDDM); prospective perioperative database) liver injury was classified by an experienced pathologist using established criteria for steatosis and sinusoidal injury (SinDilat) and then compared with preoperative CTx and postoperative outcome. 59% of the operations were (extended) hemihepatectomies (ExtRes), 41% segmental or atypical resections (LimRes). Before resection 66% had received CTx (34% FU-based (FU), 20% oxaliplatin-based (Oxa), 10% irinotecan-based (Iri) and 3% Oxa+Iri. The interval between CTx and surgery was always ≥ six weeks. Results: Mortality was 3/102 (2.9%). Any complication occurred in 48%, hepatic insufficiency in 5.9%. Hepatic steatosis > 20% was found in 35% (half of them with steatosis > 50%). Patients with a BMI > 25 had a higher rate of steatosis > 20% (45% vs 24%; p<0.04). No risk factor for grade 2 and 3 SinDilat was found. Although there was a tendency Oxa and Iri were not significantly correlated with hepatic injury. Neither a CTx per se nor the different CTx-regimens nor the extent of hepatic injury showed any influence on mortality, complication rate or hepatic insufficiency. Patients with IDDM had a higher mortality (25% vs 1% without IDDM); p<0.03), complication rate (75% vs 46%; p=0.05) and a higher rate of hepatic insufficiency (25% vs 4%; p<0.05). Patients undergoing ExtRes also had a higher complication rate than patients with LimRes (p<0.02). None of the 32 patients with preoperative Oxa or Iri died or developed hepatic insufficiency. Conclusions: In our experience hepatic injury/parenchymal changes were influenced rather by BMI than by preoperative CTx (-regimen). Neither preoperative CTx nor liver injury increased perioperative morbidity. Patients with IDDM were at a rather high perioperative risk.