Understanding non-tumor factors affecting surgery outcomes for colorectal liver metastases (CRLM) is crucial for reducing disparities.

• Only 20% of the 14,047 patients with synchronous CRLM received local treatment.
• Older age (OR 0.94) and female sex (OR 0.87) decreased the likelihood of receiving surgery, while higher socioeconomic status improved access (OR 1.35 for middle, OR 1.61 for high).
• Non-tumor factors like age and ASA score significantly influenced postoperative morbidity and mortality.

Addressing these disparities can enhance surgical access and improve patient outcomes.