Treatment of Irresectable Colorectal Liver Metastases by Combination of Liver Resection and Percutaneous Tumor Ablation: Mid-term Outcome.

Abstract

Purpose: Primary resection of liver metastases in colorectal cancer remains the leading curative approach. However, a small future liver remnant or central localization of metastases often prevent resectability. In such cases, combining resection with percutaneous ablation may offer a curative-intent treatment option. This study aims to evaluate the oncologic results and morbidity of this combined treatment.

Materials and methods: In this retrospective study, 21 patients with advanced colorectal liver metastases underwent a two-stage treatment consisting of planned incomplete resection and percutaneous ablation. Outcomes assessed included overall survival and intrahepatic progression-free survival. Main exclusion criteria were extrahepatic disease and ablation of metastases > 3 cm. Results are reported as medians with 95% confidence intervals and standard deviation.

Results: The median number of preoperative intrahepatic metastases was 5 [2-13]. Follow-up was available for 95% of patients, with a median follow-up of 21 months. Intra- und extrahepatic recurrences occurred in 81% (17/21). Median intrahepatic progression-free survival was 5 [0-44] months. Median overall survival was 36.5 [6.6-55] months, resulting in a 1-year survival rate of 91%. Twelve patients (57%) passed away. Technical success was achieved in 90%. Three major complications occurred, all of which were successfully treated.

Conclusion: In patients with partially unresectable colorectal liver metastases, a two-stage approach combining resection and percutaneous ablation represents a potential curative-intent strategy, particularly when intraoperative ablation is not feasible. Despite high recurrence rates, OS was comparatively long relative to systemic therapy. Further studies are needed to explore treatment sequencing, perioperative therapies, and advanced ablation technologies for optimizing the concept. Ultimately, treatment must be individualized based on the patient's disease profile and institutional capabilities.

Key points: · A two-stage approach combining resection and percutaneous ablation represents a potential curative-intent strategy in partially irresectable colorectal liver metastases.. · High recurrence rates occur, but overall survival remains comparatively long.. · Individualized, interdisciplinary treatment planning optimizes patient outcomes.. · Further research is needed on sequencing, perioperative strategies, and ablation technologies..

Citation format: · Lokancevic T, Keil S, Bruners P et al. Treatment of Irresectable Colorectal Liver Metastases by Combination of Liver Resection and Percutaneous Tumor Ablation: Mid-term Outcome. Rofo 2026; DOI 10.1055/a-2781-8926.