HPB : the official journal of the International Hepato Pancreato Biliary Association · 2026
Practice patterns and implementation of combined ablation and resection (CARe) strategies for colorectal liver metastases: a pan-European survey.
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Pilz da Cunha Gabriela, Schulz Hannah H, Kok Niels F M, Meijerink Martijn R, Swijnenburg Rutger-Jan
Аннотация
BACKGROUND: Combined ablation and resection (CARe) is a parenchymal sparing alternative to more extensive liver resection in selected patients with colorectal liver metastases (CRLM). This study aims to characterize the degree of implementation of CARe and approaches across Europe.
METHODS: An online survey was conducted among members of the European-African Hepato-Pancreato-Biliary Association, between June and August 2025, to assess current CARe practice patterns, including implementation, strategies, and clinician perspectives.
RESULTS: Overall, 91 responses from 77 centres across 23 countries were analysed. The majority of respondents worked at university hospitals (81%). 91% of centres indicated that CARe is available at their institution, though most centres (65%) report using CARe in ≤20% of resections. Neither high institutional ablation nor high resection volumes were significantly associated with CARe implementation, although a trend was observed for ablation volume (p = 0.068). Minimally invasive CARe approaches are adopted in the majority (89%) of centres performing CARe, including both ultrasound guided (percutaneous (59%) or laparoscopic (73%)) and CT-guided techniques (54%), performed intraoperatively or in sequential sessions. Notably, despite the parenchymal sparing potential of CARe, 20% of respondents indicated a preference for major hepatectomy when both strategies could achieve complete tumour clearance.
CONCLUSION: Although widely available among responding centres, substantial variation in institutional implementation and strategies for CARe, highlight the need for evidence-based best practice recommendations and training programs for ablation.
METHODS: An online survey was conducted among members of the European-African Hepato-Pancreato-Biliary Association, between June and August 2025, to assess current CARe practice patterns, including implementation, strategies, and clinician perspectives.
RESULTS: Overall, 91 responses from 77 centres across 23 countries were analysed. The majority of respondents worked at university hospitals (81%). 91% of centres indicated that CARe is available at their institution, though most centres (65%) report using CARe in ≤20% of resections. Neither high institutional ablation nor high resection volumes were significantly associated with CARe implementation, although a trend was observed for ablation volume (p = 0.068). Minimally invasive CARe approaches are adopted in the majority (89%) of centres performing CARe, including both ultrasound guided (percutaneous (59%) or laparoscopic (73%)) and CT-guided techniques (54%), performed intraoperatively or in sequential sessions. Notably, despite the parenchymal sparing potential of CARe, 20% of respondents indicated a preference for major hepatectomy when both strategies could achieve complete tumour clearance.
CONCLUSION: Although widely available among responding centres, substantial variation in institutional implementation and strategies for CARe, highlight the need for evidence-based best practice recommendations and training programs for ablation.