Background:　Currently,　guidelines　prohibit　the　addition　of　targeted　drugs　in　neoadjuvant　chemotherapy　(NAC)　for　initially　resectable　colorectal　liver　metastasis　(CRLM).　Objective:　Nevertheless,　efficacy　data　of　NAC　combined　with　bevacizumab　(Bev)　for　initially　resectable　CRLM　with　risk　factors　for　recurrence　(RFR)　are　lacking.　Designs:　We　conducted　a　multicenter　real-world　cohort　study　to　retrospectively　analyze　the　efficacy　and　feasibility　of　NAC　combined　with　Bev　for　CRLM　with　RFR.　Methods:　The　patients　were　divided　into　the　NAC　alone　group　and　NAC　combined　with　the　Bev　group.　We　designated　progression-free　survival　(PFS),　objective　response　rate　(ORR),　and　overall　survival　(OS)　as　the　outcomes.　Kaplan–Meier,　Cox　proportional　hazards　regression　models,　and　subgroup　analysis　were　utilized.　RFR　was　a　clinical　risk　score　of　3–5.　Subgroup　analysis　was　applied　to　explore　which　subgroup　was　more　suitable　for　NAC　combined　with　Bev.　Results:　Between　2015　and　2020,　this　multicenter　real-world　study　encompassed　335　CRLM　patients　from　six　medical　centers　who　underwent　curative　hepatectomy　following　NAC.　Two　hundred　seventeen　patients　were　in　the　NAC　alone　group,　and　118　received　NAC　combined　with　Bev.　The　NAC　alone　group　exhibited　an　ORR　of　51.15%,　compared　to　66.95%　in　the　NAC　combined　with　Bev　(p　=　0.005).　The　R0　resection　rates　achieved　91.71%　for　the　NAC　alone　group　and　94.92%　for　the　NAC　combined　with　Bev　(p　=　0.276).　Three-year　PFS　rate　was　27.6%　for　NAC　alone　and　41.5%　for　the　NAC　combined　with　the　Bev　group　(p　=　0.006).　Furthermore,　the　3-year　OS　was　calculated　to　be　57.0%　for　the　NAC　alone　and　66.7%　for　the　NAC　combined　with　Bev　patients　(p　=　0.079).　Conclusion:　For　initially　resectable　CRLM　patients　with　RFR,　NAC　combined　with　Bev　exhibited　a　higher　ORR　and　longer　PFS.　Chinese　clinical　trial　registry:　ChiCTR2400082966.　©　The　Author(s),　2025.