In the chemotherapy group, the mean (SD) follow-up time was 16 (12) months (range, 5-45 months; median, 12 months). The mean (SD) interval from the diagnosis to the start of chemotherapy was 8 (2) days (range, 6-12 days; median, 8 days), which was significantly shorter than that observed in the resection group, as expected. Seven patients (30%) had severe complications related to unresected bowel tumor. Two colon perforations, 1 intestinal hemorrhage, and 1 bowel obstruction required emergency surgery. Three cases of intestinal obstructions were initially managed with endoscopic stent placement, but 2 patients required surgery owing to bowel perforation or stent dislocation. In these 7 patients, complications occurred 3, 7, 9, 10, 14, 16, and 22 months (mean, 11 months; median, 10 months) after the initial diagnosis. In 3 of these patients, a reduction in the size of metastatic liver lesions was obtained by chemotherapy, although they still remained unresectable. Surgical mortality and morbidity rates were 14% (1 patient died of septic shock after bowel perforation), and 43% (3 patients showed prolonged intestinal paralysis, pleural effusion, and wound infection), respectively. All but 3 patients were able to continue systemic chemotherapy. Twenty-one patients (91%) died of disease, whereas 2 patients were still alive 37 and 43 months after the start of chemotherapy. The first is alive with unresectable disease in the liver and stented bowel tumor; the second, after shrinkage of liver metastases, underwent successful synchronous curative resection of the bowel tumor and hepatic deposits. The mean and median overall survival time were 17 and 12 months, respectively; the 1- to 4-year actuarial survival rates were 61%, 17%, 13%, and 0%, respectively (Figure 1).