Resection vs. Thermal Ablation for Colorectal Liver Metastases: Resection Remains the Standard

For many years, surgical resection has been the gold standard treatment for colorectal liver metastases (CLM). Resectability is therefore the cornerstone of CLM classification and management, and its concept has expanded considerably through technical advances and effective onco-surgical collaboration. While thermal ablation (radiofrequency, microwave) is an effective treatment for small CLM, it carries significant limitations beyond tumor size, including lesion location, operator-dependence, and the absence of histological proof of efficacy. Furthermore, local recurrence rates have been shown to be higher than after surgery, particularly when lesions exceed 3 cm. Conversely, ablative treatments are less morbid and require shorter hospital stays, even though current surgery for CLM — especially upfront resectable lesions — is now safe and minimally invasive (enhanced recovery programs, laparoscopic/robotic approaches). In practice, the therapeutic choice must remain open and be discussed within a multidisciplinary tumor board, integrating the characteristics of the metastasis or metastases, molecular profile (KRAS status), patient comorbidities, and available local expertise. Resection remains the standard; ablation is nonetheless a valid alternative in selected cases.