Background and objective <p>Colorectal cancer is among the most common global malignancies. Approximately 25% of patients present with liver metastases at diagnosis. Debate persists over whether to choose simultaneous or staged resection due to the varying evidence regarding outcomes and patient eligibility criteria for each approach. This study aims to assess and compare both short- and long-term surgical outcomes of simultaneous and staged resection approaches.</p> Methods <p>We performed a systematic review and meta-analysis of 18 articles published from 2000 to 2024 on PubMed and Web of Science, to compare outcomes between the two methods for patients with colorectal cancer and liver metastases.</p> Results <p>Simultaneous resection showed no statistically significant difference in hospital stay compared with staged resection (MD − 1.07 days, 95% CI − 8.00 to 5.85; <i>P</i> = 0.76; I² = 98%). Morbidity was also similar (OR 0.92, 95% CI 0.75–1.13; <i>P</i> = 0.41). Overall mortality was higher after staged resection (OR 1.96, 95% CI 1.24–3.09; <i>P</i> = 0.004). Differences in 30- and 90-day mortality, postoperative complications, and recurrence were not statistically significant, with wide confidence intervals and considerable heterogeneity across studies.</p> Conclusion <p>Simultaneous resection of colorectal cancer with liver metastases appears safe and feasible in appropriately selected patients, with no statistically significant differences in hospital stay, complications, recurrence, or short-term mortality when compared with staged resection. Although some outcomes showed directional trends favoring simultaneous surgery, these findings were not statistically significant and were affected by high heterogeneity. Careful patient selection remains essential, and further high-quality studies are needed to better define candidates most likely to benefit from either approach.</p>