Background <p>Early recurrence of colorectal liver metastases (CRLM) after hepatectomy is generally considered high-risk; however, the prognosis may differ depending on whether recurrence is confined to a single site or involves multiple sites. This study evaluated post-progression survival (PPS) according to recurrence pattern at first relapse in patients with early recurrence.</p> Methods <p>We retrospectively reviewed consecutive patients who underwent initial curative-intent hepatectomy for CRLM at Chiba University Hospital between 2012 and 2022. Patients with recurrence within 12 months were classified as having single-site or multi-site recurrence at first relapse based on the number of involved organs or anatomically distinct compartments. PPS was calculated from the time of first recurrence and analyzed using Kaplan–Meier and Cox regression methods. Post-recurrence treatments, including salvage metastasectomy, were recorded.</p> Results <p>Among 151 patients, 78 (51.7%) developed recurrence within 12 months: 43 with single-site and 35 with multi-site recurrence at first relapse. PPS was significantly longer in the single-site group than in the multi-site group (log-rank <i>p</i> = 0.016); median PPS was not reached in the single-site group and was 31 months in the multi-site group. On multivariable analysis, multi-site recurrence remained independently associated with poorer PPS (hazard ratio: 1.96, 95% confidence interval: 1.04–3.71; <i>p</i> = 0.037). Salvage metastasectomy was performed in 35 patients (44.9%); the proportion was comparable between the single-site and multi-site groups (46.5% vs. 42.9%, respectively; <i>p</i> = 0.821).</p> Conclusions <p>Among patients with early recurrence after hepatectomy for CRLM, the anatomical extent of the first relapse further stratified PPS. Multi-site recurrence was independently associated with poorer PPS, suggesting that early recurrence is not a single prognostic entity but comprises clinically heterogeneous subgroups.</p>