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Background <p>The optimal local treatment for small colorectal liver metastases (CRLM) remains debated. We compared thermal ablation with liver resection for CRLM ≤ 3&#xa0;cm using data from randomized and propensity score-matched studies.</p> Methods <p>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&#xa0;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.</p> Results <p>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<sup>2</sup> = 25%) or DFS/PFS (HR 1.01, 95% CI 0.90–1.14; I<sup>2</sup> = 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<sup>2</sup> = 0%) and major complications (RR 0.35, 95% CI 0.22–0.55; I<sup>2</sup> = 0%).</p> Conclusions <p>In selected patients with CRLM ≤ 3&#xa0;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.</p>

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Thermal ablation versus liver resection for small colorectal liver metastases (≤ 3 cm): a systematic review and meta-analysis of randomized and propensity score-matched studies

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Lei Su,
  • Chengtao Yu,
  • Chi Zhang,
  • Wei Hu,
  • Weiqiang Qu,
  • Zheng Zhang,
  • Jiankui Luan

摘要

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; I2 = 25%) or DFS/PFS (HR 1.01, 95% CI 0.90–1.14; I2 = 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; I2 = 0%) and major complications (RR 0.35, 95% CI 0.22–0.55; I2 = 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.