The liver is the first, most common and often unique site of metastasis of colorectal cancer. Approximately 50% of colorectal cancer patients develop recurrent disease involving the liver during the course of their diseases.

Nowadays, multiple treatment options for colorectal metastases are available, including hepatic resection, chemoembolization, intra-arterial and systemic chemotherapy and thermal ablative therapies (cryoablation, laser-therapy and radiofrequency ablation [RFA]) (1, 2).

Over the past few years, advances in diagnostic imaging modalities such as contrast-enhanced ultrasound, multi-detector helical computed tomography (CT) and magnetic resonance imaging (MRI) with liver-specific contrast agents allow early detection and accurate quantification of liver metastatic involvement (3–6). As a result, correct selection of patients for different treatment options is usually possible.

If cure is the therapeutic goal, hepatic resection remains the most effective treatment option for liver metastases of colorectal origin (1–2, 7–10). However, patients eligible for resection are only a minority (30% to 35%, according to surgical literature) (11) because of many different occurrences: patients with metastases in difficult anatomical locations (e.g., adjacent to large blood vessels) or with new metastases or local recurrences after previous hepatic resection, patients with multiple bilobar liver metastases, patients refusing or not eligible for surgery for general health reasons or associated pathological conditions that increase anesthesiologic risk cannot undergo resection and are all potential candidates for local ablation therapy. In fact, there are several potential advantages of local ablation over surgical resection:

1. Feasibility of treatment in previously resected patients and nonsurgical candidates due to number and/or intrahepatic location of metastatic deposits, age and co-morbidity;

2. […]