Thermal Ablation Is Equally Effective and Safer than Surgical Resection for Small Colorectal Liver Metastases

van der Lei S, Puijk RB, Dijkstra M, et al. Thermal Ablation versus Surgical Resection of Small-Size Colorectal Liver Metastases (COLLISION): An International, Randomised, Controlled, Phase 3 Non-Inferiority Trial. Lancet Oncol. 2025;26(2):187-199.

Available evidence supports the conclusion that thermal ablation treatment of small liver metastases from colorectal cancer is associated with fewer adverse events, faster recovery, and similar oncologic outcomes compared with surgical resection.

This randomized trial included patients (n = 300) with 10 or fewer metastatic lesions ≤3 cm in diameter; patients were randomized to receive thermal ablation or surgical resection. The outcome of interest was overall survival. Follow up data for a median interval of 28.9 months were available.

Overall survival was similar (60%) in the two comparison groups. Serious adverse events occurred in 7% of the thermal ablation group and 20% of the surgical resection group. Three treatment-related deaths occurred in the surgical resection group.

The authors recommended that thermal ablation be considered when choosing a management approach for patients with small colorectal cancer liver metastases.