One-stage surgery beats two-stage for unresectable liver metastases.

• Median overall survival was 46.5 months for one-stage versus 34.0 months for two-stage (p = 0.043).
• Complication rates were similar: 11% for one-stage and 13% for two-stage (p = 0.567).
• Local treatment was more successful with one-stage surgery, achieving complete resection or ablation in 52 patients compared to 29 in the two-stage group (p < 0.001).

Consider one-stage approaches as a first option for eligible patients, with two-stage surgery reserved for more complex cases.