We reviewed 63 patients with metachronous ovarian metastases from colorectal carcinoma to determine the natural history of this problem, and whether aggressive surgical treatment is beneficial. Ovarian metastases usually occurred in younger patients (mean age, 51 years) and in 55.5% of the patients, the metastases were part of diffuse intra-abdominal disease. The mean survival rate for all patients following surgery was 16.6 months. The survival rate did not correlate with menstrual status, interval to recurrence, or Dukes' stage of the original cancer. Ability to remove all gross disease at the time of oophorectomy was the major determinant of survival. Surviving patients who were rendered disease free surgically (n = 15) lived a mean of 48 months compared with 9.6 months for patients with localized, but unresectable disease (n = 9), and eight months for patients with diffuse disease (n = 35). Surgical attempts to remove all gross disease seem to result in significantly improved survival rates even though a cure is rare. Bilateral oophorectomy is warranted as part of the palliative treatment of women who are seen with stage D cancers to prevent the development of large symptomatic metastases that require further therapy.