Abstract: Colorectal liver metastases (CRLM) are a major cause of death in patients with colorectal cancer. Approximately 30%-50% of patients develop liver metastases during the disease course, and only about 20% are candidates for surgical resection. Image-guided ablation is minimally invasive and repeatable and has become an important component of the multidisciplinary management of CRLM. This review summarizes the clinical applications of ablation, factors influencing efficacy, comparisons with surgical resection, and its role in multimodal treatment, and discusses future directions. Current evidence suggests that, in carefully selected patients with oligometastatic liver disease, particularly those with lesions ≤3 cm, thermal ablation is non-inferior to surgical resection in terms of overall survival and is associated with a lower incidence of adverse events. In selected patients with unresectable, liver-limited disease and a limited number of metastases, adding aggressive local treatment, including ablation, to systemic therapy may improve long-term survival. Advances in image navigation and artificial intelligence may further expand and refine the role of ablation in CRLM management.

Key words: Colorectal liver metastases, Image-guided ablation, Multimodal therapy, Prognosis