Surgical resection is the standard of care for patients with colorectal liver metastases. Thermal ablation has emerged as an alternative management approach for small lesions (≤3 cm diameter), although how it compares with surgery is unclear because most of the available evidence is from meta-analyses of retrospective studies. Now, results from the phase III COLLISION trial demonstrate that thermal ablation results in noninferior efficacy outcomes and has a superior safety profile relative to resection.

In this trial, 296 patients with colorectal liver metastases were randomly allocated (1:1) to undergo thermal ablation or resection of all target lesions (median 2, range 1–10). Of note, 18% and 35% of patients in the thermal ablation and resection groups, respectively, underwent both approaches. Overall survival (OS) was the primary end point.