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Introduction: Surgery in the management of patients(pts) with peri-ampullary liver metastasis remains controversial. We assess safety and efficacy of curative intent surgery for peri-ampullary liver metastasis.Methods: Between 1993-2009, 40 pts underwent resection and/or radiofrequency ablation (RFA) for peri-ampullary liver metastasis. Clinicopathologic and outcome data were collected and analyzed.Results: Location of primary tumor was pancreatic head (n=20), ampullary (n=10), distal bile duct (n=5) or duodenum (n=5). Most pts (n=27) presented with synchronous disease. Of pts with metachronous diasease (n=13), median time to liver metastasis was 22mo. The majority of pts had solitary lesions (n=34); median lesion size was 2.7cm. Pts with simultaneous disease had smaller lesions (median, 0.9cm) vs pts with metachronous disease (median, 3.0cm)(p<0.01). At surgery, pts underwent resection alone (n=31), RFA alone (n=8), or resection+RFA (n=1). RFA alone (n=7, p<0.001) and resection ≥3 segments (n=5, p=0.009) were performed more often in pts with metachronous disease. Post-operative morbidity and mortality was 30% and 5% respectively. Most pts (55%) recurred with a median recurrence-free survival of 10mo. Intra-hepatic recurrence was the predominant pattern of initial recurrence (86%). Overall 1- and 3- year survival was 55% and 18%. Survival was not associated with synchronous vs metachronous presentation (p>0.05). Pts with pancreatic or distal bile duct tumors had a worse survival (median, 13mo) vs pts with ampullary or duodenal tumors (median, 23mo)(Fig 1).Conclusion: Surgery for peri-ampullary liver metastasis is associated with low morbidity and mortality. While survival is possible in select pts, outcome following surgery of peri-ampullary metastasis remains poor. Pts with ampullary or duodenal primaries benefit most from curative intent surgery.