Rural residency correlates with lower treatment rates and worse outcomes for colorectal liver metastases (CRLM).

• Among nearly 35,000 CRLM patients, 21.7% were rural dwellers; they had 12% lower odds of receiving curative-intent liver-directed therapy and 14% lower odds of systemic chemotherapy.
• Despite higher odds of primary tumor resection (12%), rural patients experience significantly poorer overall survival (HR 1.08) compared to urban counterparts.

These disparities highlight the need for targeted interventions to improve access and outcomes for rural patients with CRLM.