High compliance with enhanced recovery programs does not significantly improve survival after liver surgery.

• Among 1,860 patients, only 24.4% achieved high compliance.
• Twelve-month overall survival rates were similar: 96% for high compliance vs. 92% for low compliance (p = 0.11).
• Long-term mortality risks included metastatic disease and prolonged operative times.

Only patients with colorectal liver metastases showed improved survival linked to high compliance, emphasizing the need for careful patient selection.

• Compliance did reduce perioperative complications, but not survival outcomes.