Hepatectomy outperforms microwave ablation for colorectal cancer liver metastases, with anatomical location affecting ablation outcomes

Objective This study aimed to compare the clinical efficacy of hepatectomy and microwave ablation (MWA) for colorectal cancer liver metastases (CRLM), and to further clarify the clinical value and limitations of MWA in the treatment of high-risk CRLM lesions. Methods A total of 98 patients with CRLM treated between July 2008 and February 2019 were retrospectively enrolled. Among them, 31 patients underwent hepatectomy and 67 received MWA. Tumor characteristics and long-term prognosis were compared between the two groups. A total of 105 CRLM lesions were further subgrouped into high-risk location ( n = 36) and non-high-risk location ( n = 69) for stratified analysis. Results Patients treated with hepatectomy achieved significantly better recurrence-free survival (RFS) and overall survival (OS) than those treated with MWA. In the MWA cohort, lesions <3 cm in diameter could be completely ablated regardless of anatomical location. For tumors >3 cm, the complete ablation rate was significantly lower in high-risk lesions than in non-high-risk lesions. Multivariate analysis confirmed that tumor diameter was an independent risk factor for incomplete ablation. Conclusion Hepatectomy provides superior long-term survival benefits over MWA for patients with CRLM. MWA exhibits unsatisfactory efficacy for high-risk lesions, especially those larger than 3 cm in diameter.