Whether resection of recurrent colorectal cancer liver metastases (CLMs) can be safely performed after prior hepatectomy, especially after two-stage hepatectomy (TSH), and to what extent this aggressive surgical approach may impact patient outcomes and prolong survival, are important issues to investigate. To this end, Imai and colleagues recently published the Hospital Paul Brousse experience with resection of recurrent CLMs after TSH (1). In this study, the authors analyzed 93 patients who underwent TSH, among whom 81 had "globally curative"surgery, when all known disease—including extrahepatic disease if present—was successfully resected. Of these 81 patients, 62 (76.5%) experienced recurrence. For their entire study cohort, repeat liver surgery was ultimately performed in more than half of the patients, and survival for these patients was significantly greater than that for patients who did not undergo resection (45.8% vs. 26.3%, P=0.004). In fact, repeat hepatectomy for recurrence was the strongest independent predictor for improved survival. As the authors conclude, these results underscore the value of oncologic surveillance and the critical role of repeat hepatectomy. The present work expands on the concept of "third hepatectomy" previously reported by the same authors, focusing on those patients who have undergone the most aggressive surgical treatment of their prior CLMs in the form of TSH involving portal vein embolization and major hepatectomy (2).