Patients with colorectal liver metastases (CRLM) in New York City are significantly less likely to undergo potentially curative liver resection compared to those in New York State.

• CRLM resection rates were 20% in NYC versus 24% in NYS, with factors like low-volume facilities (OR 0.23) and positive lymph nodes (OR 0.34) decreasing the likelihood of surgery.
• Surprisingly, 18% of patients chose farther, lower-volume centers over closer, higher-volume facilities, suggesting potential underuse of specialized care.

These findings highlight the need for targeted interventions to improve access to curative surgical options for CRLM in urban settings.