Purpose: Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) have local and systemic effects that are hypothesised to promote tumorigenesis. Nevertheless, their impacts on clinical outcomes are not well understood. While obesity is associated with increased cancer incidence, previous meta-analyses have not found associations between VAT or SAT and cancer survival. Our paper investigates whether the preoperative visceral-to-subcutaneous fat ratio (VSR) or visceral-to-total fat ratio (VTR) measured by computed-tomography predicts survival or surgical complications in colorectal cancer. Methodology: A systematic search of Embase and Medline was conducted from 2013 to July 2023 using keywords and subject headings. Pooled hazard ratios for overall and disease-free survival were calculated using a restricted-maximum likelihood estimator. Results relating to postoperative outcomes were qualitatively synthesised. Results: Thirteen studies that reported associations with survival and twelve studies that reported associations with postoperative complications were included. Pooled hazard ratios for overall and disease-free survival were not significant at 95% confidence. However, higher VSR or VTR predicted worse outcomes in all but one of the studies that reported associations with postoperative complications. Conclusions: Higher VSR or VTR predict worse postoperative complications but are not associated with overall or disease-free survival in colorectal cancer. The lack of a significant relationship between VSR or VTR and survival may be due to heterogeneity between studies, a potentially non-linear relationship between variables, or protective effects from visceral adiposity.