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BACKGROUND: Preoperative chemotherapy before liver resection can determine hepatic parenchyma damage with a negative influence on the patients’ postoperative outcome.AIM: The aim of this prospective study was to assess the effects of preoperative chemotherapy on hepatic parenchyma in a consecutive and homogeneous series of patients evaluating the outcome in terms of postoperative morbidity at 30 days after surgery, liver function and the need of transfusion.MATERIALS AND METHODS: Eighty-seven consecutive patients that underwent liver resection for colorectal metastases in our surgical unit were included: the patients were divided into two groups: group 0 with 39 patients (45%) who only underwent liver resection and group 1 with 48 patients (55%) who received preoperative chemotherapy. All variables, which could influence surgical outcome were analyzed: hepatic injury found on histology, liver function tests ( total bilirubin, ALT, AST, Albumin, INR) before surgery till hospital discharge, chemotherapy treatment (5FU, Oxaliplatin, Irinotecan, monoclonal antibodies, intraarterial or systemic), number of infusions, interval between chemotherapy and surgery, need of transfusion, postoperative complications, length of hospital stay, comorbidities. Univariate, bivariate and multivariate analyses were performed.RESULTS: The probability of developing severe steatosis (2,58 times) and necrosis (4 times) was higher in patients that received preoperative chemotherapy; furthermore, the risk of steatohepatitis in these patients was higher. The values of liver function tests of group 1 compared to group 0, as expected, were worse (p=0.007). The number of infusions did not imply a higher number of surgery complications (p=0.075), but it correlated directly with bilirubin values and inversely with albumin values. No correlation was found between time interval from the last infusion and surgery and surgical outcome. With regard to transfusion need and length of hospital stay no difference between the two groups was found. At univariate analysis, most differences resulted to be significant but were not confirmed in the multivariate analysis. CONCLUSIONS: Preoperative chemotherapy can cause liver damage without a negative influence on surgical outcome; therefore liver resection is safe also after chemotherapy.