Outcomes of Combined Hepatectomy and Intraoperative Ablation for Multiple Colorectal Liver Metastases: A Single-Center Retrospective Study

Introduction: Radical hepatectomy is the standard curative treatment for colorectal liver metastases (CRLMs). However, extensive resection may be contraindicated in patients with insufficient liver reserve or anatomically complex disease. Although ablation therapy is generally not recommended as a primary curative modality in current guidelines, intraoperative ablation may facilitate parenchymal-sparing, curative-intent treatment in selected high-risk patients. Methods: This retrospective cohort study included 118 patients who underwent curative-intent hepatectomy for multiple CRLM. Patients were categorized into hepatectomy-only (Hx) and hepatectomy plus intraoperative ablation (Hx + Abl) groups, and propensity score matching (PSM) generated 29 balanced pairs. Overall survival (OS) and hepatic progression-free survival (HPFS) were compared using a log-rank test. Cox regression identified predictors of OS, and receiver operating characteristic (ROC) analysis evaluated tumor size associated with local recurrence after ablation. Results: Before PSM, the HX + Abl group showed higher tumor burden and Beppu scores, and demonstrated inferior OS and HPFS. After PSM, oncological outcomes were comparable. Perioperative outcomes, including major complications and post-hepatectomy liver failure (PHLF), were similar. Preoperative chemotherapy was an independent predictor of OS. Among 99 ablated tumors, local recurrence occurred in 12 lesions, and ROC analysis identified tumor size ≤ 15mm as the optimal cutoff predicting local recurrence. Conclusions: In selected high-risk CRLM patients, hepatectomy with intraoperative ablation had no statistically significant difference in OS and HPFS compared with hepatectomy alone without increasing major complications or PHLF.