Thermal ablation, surgical resection, and intraoperative combination for colorectal liver metastases with curative intent: a systematic review and Bayesian network meta-analysis

Background: Surgical resection remains the standard of care for colorectal liver metastases (CRLM). Thermal ablation (TA) has recently been applied with curative intent, either as a standalone therapy or in combination with surgical resection. To assess their relative efficacy and safety, we conducted a systematic review and Bayesian network meta-analysis comparing surgical resection, TA, and hepatectomy combined with intraoperative TA (H + TA) for patients with CRLM treated with curative intent. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was performed until August 2025. Eligible comparative studies reported outcomes of surgical resection, TA (percutaneous or surgical), or H + TA. A Bayesian network meta-analysis was used to evaluate overall survival (OS), disease-free survival (DFS), morbidity, and length of hospital stay. Results: Twenty-seven studies comprising 9199 patients were included. No statistically significant differences in the 5-year OS rate or 3-year DFS rate were observed across treatment modalities. In contrast, TA was associated with a significantly lower overall morbidity rate compared to surgical resection [risk ratio (RR): 0.46; 95% credible interval (CrI): 0.32–0.62] and H + TA (RR: 0.54; 95% CrI: 0.35–0.79). Likewise, TA was associated with a shorter hospital stay than surgical resection (MD: −4.28 days; 95% CrI: −6.02 to −2.59) and H + TA (MD: −3.70 days; 95% CrI: −6.26 to −1.25). Conclusions: In the curative-intent treatment of CRLM, surgical resection, TA, and H + TA were associated with broadly comparable long-term survival rates. TA was also associated with a lower morbidity rate and a shorter hospital stay in the included studies. Given its less invasive nature and the observed survival outcomes within selected patient populations, TA may represent a reasonable alternative to surgical resection in appropriately selected patients.