Comparative Efficacy of Thermal Ablation and Surgical Resection in Patients with Colorectal Cancer Liver Metastasis: A Systematic Review and Meta-analysis.

PURPOSE

Colorectal cancer (CRC) often involves liver. However, the standard treatment for CRC with liver metastases (CRC-LM) is debatable. This meta-analysis compares the efficacy of ablation with surgical resection in CRC-LM patients.

METHODS

A systematic literature search was conducted in PubMed, ClinicalTrials.gov and Cochrane Library. Studies published during January 2020 to February 2025 and comparing any form of ablation with surgical resection in adult patients with CRC-LM were included. The primary outcomes were overall survival (OS), disease-free survival (DFS), while the secondary outcomes were recurrence patterns, length of hospital stay, and complication rates.

RESULTS

A total of 15 studies were included in the meta-analysis. The pooled analysis revealed a significant difference in OS favoring surgical resection (RR: 0.82, 95% CI: 0.73, 0.92, p = 0.001, I = 33%), while DFS showed no significant difference between the groups (RR: 0.76, 95% CI: 0.38, 1.53, p = 0.44, I = 85%). Hospital stay was significantly shorter in the ablation group (MD -1.44; 95% CI -2.18,-0.69; p = 0.0001; I = 97%), and the rate of major complications was also significantly lower with ablation (RR 0.26; 95% CI 0.18-0.38; p < 0.00001; I = 0%). Additionally, ablation and resection were comparable in terms of both local recurrence (RR 1.27; 95% CI 0.86-1.86; p = 0.23; I = 38%) and appearance of new lesions (RR 0.98; 95% CI 0.75-1.29; p = 0.90; I = 9%).

CONCLUSION

Surgical resection offered superior OS compared to thermal ablation for CRC-LM patients. However, thermal ablation was associated with shorter hospital stay and fewer major complications, highlighting its value as a less invasive alternative in selected patients.