Staged resection is safer and offers better outcomes than simultaneous resection for patients with initially unresectable colorectal liver metastases.

• Staged resection had lower overall complications (35.8% vs. 48.9%, p=0.014) and major complications (14.8% vs. 24.1%, p=0.027).
• Staged resection significantly improved relapse-free survival (HR=0.780, p=0.030) and liver-specific survival (HR=0.737, p=0.011).

Adopting staged resection could enhance surgical results for these patients.

• Multivariable analysis confirmed benefits in survival metrics for staged over simultaneous resection.