A persistent rise in the carcinoembryonic antigen (CEA) level measured every 2 to 3 months during the postoperative years following resection of a colorectal malignancy is an indication for a thorough search for a possible recurrence. The original operation and pathologic reports are reviewed because they may provide a clue as to where the recurrence is located. However, the liver is the chief organ to be investigated by imaging scans (CT, MRI, PET-CT), abdominal echograms, and liver function studies as well as a complete survey of the colorectal system by colonoscopy. Evidence of metastases to the lungs or diffuse involvement of the abdomen or bone generally contraindicates surgical intervention, but local excision is usually considered in a good risk patient with a definite steady increase in the CEA level. Further, a hepatic lobectomy may be considered for a metastasis too large for local excision. Radio immuno-guided detection of recurrent malignancy may be useful in localizing metastasis which otherwise would be missed as well as providing evidence of complete resection of the tumor. The 5-year survival rates following the removal of hepatic metastases tend to be encouraging. The patient should be fully informed of the reasons for the “second look” exploration as well as the uncertainty of being cured of recurrence of malignancy.