Background liver fibrosis intensifies the risk of intrahepatic recurrence after surgery for colorectal liver metastases, impacting surgical decision-making.

• Intrahepatic recurrence occurred in 36.3% of patients post-surgery, with 58.3% in the fibrosis group vs. 29.5% in the non-fibrosis group (p = 0.019).
• Each 1% increase in fibrotic area raised recurrence risk by 45% (hazard ratio 1.45; p = 0.02).

Surgeons should consider evaluating liver fibrosis histologically to better stratify patients’ postoperative risks.