Background: The PETCAM randomized trial evaluated the effect of preoperative PET-CT (vs. no PET-CT) on surgical management in patients with colorectal cancer liver metastases. This trial resulted in 8% change in surgical management, including a higher proportion of major liver resections in the PET-CT arm. This study is the long-term follow up of the PETCAM trial and aims to compare the disease-free (DFS), overall survival (OS), and long-term clinical course of enrolled patients. Methods: Recruitment to the trial occurred between 2005-2010, with last follow-up in 2013. Data on recurrence, management and mortality from 2013-2017 was collected retrospectively. Cox proportional Hazard Models were used to calculate risk for recurrence and death. OS was calculated with Kaplan-Meir method and compared with log-rank test. Results: At 5 years, 172/404 (43%) patients were alive. There were no differences in DFS (HR: 1.13, 95%CI: 0.89-1.43) or OS (HR: 1.02, 95%CI: 0.78-1.32) between groups. Median DFS was 17 months, 95%CI: 14-19. Risks factors for recurrence were: extrahepatic disease, liver tumour size, nodal stage and disease-free duration. Median OS was 51 months, 95%CI: 44-64. During the follow-up period, 264/368, 72% patients recurred, mostly lung (51%) and liver (41%); 120/264 (46%) received chemotherapy and 112/264, 42% were re-resected, with a recurrence of 72% (81/112). Median OS following first recurrence was 28 months, 95%CI: 24-31. Most important risks factors for death following recurrence are node-positive disease, more than one recurrence site and disease-free duration < 5 months. Conclusions: PET-CT did not improve DFS or OS. Recurrence following liver resection is common. Prognosis following recurrence is worse compared to first recurrence. Patients with high risk factors should not undergo surgical resection. Clinical trial information: NCT00265356