Social and Surgical Drivers of Survival in Colorectal Liver Metastases: An NCBD Analysis

ABSTRACT Background and Objectives Among patients with colorectal cancer, the liver is the most common site of metastases and is frequently the only site of disease. Curative intent resection offers the best chance for survival; however, access to surgery and outcomes may be influenced by social drivers of health. Methods Using the 2022 National Cancer Database, we identified adults with colorectal liver metastases (CRLM) without extrahepatic spread. Patients were categorized into four surgical groups: combined primary and liver resection, liver‐only resection, primary‐only resection, and no surgery. Demographic, socioeconomic, and clinical factors were compared, and multivariable logistic and Cox models were used to assess predictors of surgery and overall survival and mortality risk. Results Of 40,670 patients, 49.8% received no surgery, 32.8% underwent primary‐only resection, 1.6% underwent liver‐only resection, and 15.8% underwent combined primary and liver resection. Combined resections were most common among younger, privately insured patients treated at academic centers in higher‐income and higher‐education regions ( p < 0.001). Median OS differed significantly by treatment: combined resection, 59.5 months; liver‐only, 41.5 months; primary‐only, 28.2 months; and no surgery, 13.8 months. Adjusted mortality was higher for primary‐only (HR 1.66), liver‐only (HR 1.71), and no surgery (HR 3.21) compared with combined resection. Conclusions Combined primary and liver resection was associated with the longest survival and lowest mortality among patients with CRLM. Significant disparities in surgical treatment and survival were observed across key social drivers of health, underscoring the need to address inequities in access to comprehensive, curative‐intent care.