Patients with metastatic colorectal cancers have poor outcomes. Yet recent developments in the use of chemotherapy and surgery have promised improvements in survival. The aim of this study was to compare the treatment and survival for all patients presenting with stage IV colorectal cancer managed over the last 20 years at a tertiary referral center and to define independent predictors for survival.A cohort of patients with stage IV colorectal cancer treated from 1989 through 1995 served as a historical control for comparison with prospective cohorts treated from 1996 through 2002 or from 2003 through 2009. The Kaplan Meier technique was used to calculate overall survival. The Cox proportional hazards model was used to determine independent predictors of survival.A total of 313 patients with stage IV colorectal cancer were analyzed. Two-year overall survival was significantly higher in the 2003 to 2009 cohort (40.3%; 95%CI, 28.6-51.8%) than in either the 1989 to 1995 cohort (20.6%, 95%CI, 13.5- 28.6%) or the 1996 to 2002 cohort (19.3%; 95%CI, 12.8-26.9%). Significant independent predictors for overall survival included surgical resection with anastomosis (hazard ratio, 0.507; 95%CI, 0.371-0.692), surgical resection with stoma (0.578; 0.401-0.833), ASA score 3 (1.493; 1.150-1.941) or score 4 (2.532; 1.505-4.258), receiving palliative chemotherapy (0.64; 0.457-0.885), and receiving palliative radiotherapy (0.543; 0.352-0.835).In this analysis of overall survival for patients with stage IV colorectal cancer treated from 1989 through 2009, significant improvements were noted only in the last 7 years. Improvements may be related to more widespread use of palliative chemotherapy, newer chemotherapy agents, surgical excision of the primary tumor, and lower postoperative mortality.