[Treatment of colorectal liver metastases: surgical resection vs. local ablative therapy]

Surgical resection of colorectal liver metastases (CRLM) is the most common indication for hepatic resection at the present time and is considered to be the standard of care. However, advancement in imaging and local ablative therapy (LAT) techniques creates an apparently attractive alternative. The utilization of LAT is increasing for the treatment of CRLM in a non-controlled fashion.

A systematic and critical review of the Literature was undertaken according to the hierarchy of evidence based medicine (EBM). An analysis was conducted of the potential causes of the premature adoption of LAT as the first line treatment of CRLM.

There is no level 1a meta-analysis available. A single Level 1b (randomized control study) is poorly presented; 2b cohort studies with some degree of risk adjustment, present a significant superiority to resection over LAT both in local control and in Long term resuLts. A single level 3a review points out a comparable local control following LAT for lesions smaller than 3 cm, but inferior long-term results, which may be biased by patient selection. Level 3b and 4 series point to different and contradicting results, prohibiting any conclusions.

Based on the current knowLedge, LAT cannot replace surgical resection as the treatment of choice for CRLM. The increasing application of LAT in this setting is based on Level 5 evidence and is therefore inappropriate.