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Thermal ablation shows no difference in survival but lower complication rates than liver resectionThermal Ablation Shows Lower Complication Rates for Liver Metastases

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Key Takeaway
Note that thermal ablation for CRLM $\le$ 3 cm shows lower complication rates but no survival advantage over resection.

This meta-analysis evaluates the comparative efficacy and safety of thermal ablation versus liver resection for patients with colorectal liver metastases (CRLM) $\le$ 3 cm. The analysis included both randomized and propensity score-matched studies to determine outcomes for survival and complication rates.

Regarding primary outcomes, the meta-analysis found no statistically significant difference in overall survival (OS) between the two modalities (HR 0.92; 95% CI 0.79-1.07). Similarly, no statistically significant difference was observed for disease-free survival or progression-free survival (DFS/PFS) (HR 1.01; 95% CI 0.90-1.14).

In terms of safety, thermal ablation was associated with a lower risk of overall complications (RR 0.38; 95% CI 0.28-0.52) and a lower risk of major complications (RR 0.35; 95% CI 0.22-0.55) compared to liver resection. The evidence was assessed using the GRADE framework. Clinical application is limited to patients with CRLM $\le$ 3 cm, where thermal ablation may offer a safer profile without compromising survival outcomes compared to resection.

How this fits prior evidence

This meta-analysis addresses a gap in comparing local treatment modalities for small colorectal liver metastases (CRLM) $\le$ 3 cm. It complements evidence regarding minimally invasive surgical thermal ablation for liver malignancy, which showed improved safety and technical success, by specifically comparing it to liver resection in the CRLM population. While previous evidence noted that R1 vascular margins are not acceptable for CRLM in minimally invasive surgery, this meta-analysis suggests thermal ablation may offer a lower risk of complications for small lesions.

This analysis looked at how patients with small colorectal liver metastases, specifically those 3 cm or smaller, fared when treated with thermal ablation compared to liver resection. The study combined data from both randomized trials and studies matched by patient characteristics to compare the two methods.

Researchers found that both methods resulted in similar overall survival rates. There was also no significant difference in how long patients lived without their disease progressing or returning. While the survival outcomes were similar, the data showed that patients who underwent thermal ablation had a lower risk of experiencing overall complications and major complications compared to those who had surgery.

Because the survival outcomes were nearly identical, these results suggest that thermal ablation could be a viable option for specific patients. However, because this is a meta-analysis of existing data, the results should be discussed with a doctor to determine the best treatment plan based on an individual's specific health needs.

What this means for you:
Thermal ablation shows similar survival rates to surgery but may result in fewer complications for small liver tumors.

Common questions

Is thermal ablation as effective as surgery for liver metastases?

The study found no statistically significant difference in overall survival, disease-free survival, or progression-free survival between thermal ablation and liver resection for patients with tumors 3 cm or smaller. Both methods provided similar results regarding how long patients lived with the condition.

Are there fewer complications with thermal ablation?

Yes, the data showed a lower risk of both overall complications and major complications for patients who received thermal ablation compared to those who underwent liver resection. The risk of complications was significantly lower in the ablation group.

Who is this treatment for?

This specific comparison was made for patients with colorectal liver metastases that are 3 cm or smaller in size. You should talk to your doctor to see if this treatment fits your specific medical situation.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BACKGROUND: The optimal local treatment for small colorectal liver metastases (CRLM) remains debated. We compared thermal ablation with liver resection for CRLM ≤ 3 cm using data from randomized and propensity score-matched studies. METHODS: PubMed, Embase, and Web of Science were searched from inception to April 30, 2026. Eligible studies included randomized or propensity score-matched comparisons of thermal ablation with liver resection in patients with CRLM ≤ 3 cm and reported survival or complication outcomes. Hazard ratios (HRs) were pooled for overall survival (OS) and disease-free/progression-free survival (DFS/PFS). Risk ratios (RRs) were pooled for overall and major complications. Risk of bias was assessed using RoB 2 and ROBINS-I. Certainty of evidence was assessed using GRADE. RESULTS: Seven studies were included: one randomized controlled trial and six propensity score-matched or target trial emulation studies. Thermal ablation was not associated with statistically significant differences in OS (HR 0.92, 95% CI 0.79-1.07; I = 25%) or DFS/PFS (HR 1.01, 95% CI 0.90-1.14; I = 34%) compared with liver resection. Leave-one-out analysis demonstrated stable survival estimates. Thermal ablation was associated with lower risks of overall complications (RR 0.38, 95% CI 0.28-0.52; I = 0%) and major complications (RR 0.35, 95% CI 0.22-0.55; I = 0%). CONCLUSIONS: In selected patients with CRLM ≤ 3 cm, thermal ablation was not associated with statistically significant differences in OS or DFS/PFS compared with liver resection and was associated with lower complication rates. Treatment selection should remain individualized within multidisciplinary care.
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