title: [Treatment of colorectal liver metastases: surgical resection vs. local ablative therapy].
abstract: BACKGROUND
  Surgical resection of colorectal liver metastases (CRLM) is the most common indication for hepatic resection at the present time and is considered to be the standard of care. However, advancement in imaging and local ablative therapy (LAT) techniques creates an apparently attractive alternative. The utilization of LAT is increasing for the treatment of CRLM in a non-controlled fashion.
  
  
  METHODS
  A systematic and critical review of the Literature was undertaken according to the hierarchy of evidence based medicine (EBM). An analysis was conducted of the potential causes of the premature adoption of LAT as the first line treatment of CRLM.
  
  
  RESULTS
  There is no level 1a meta-analysis available. A single Level 1b (randomized control study) is poorly presented; 2b cohort studies with some degree of risk adjustment, present a significant superiority to resection over LAT both in local control and in Long term resuLts. A single level 3a review points out a comparable local control following LAT for lesions smaller than 3 cm, but inferior long-term results, which may be biased by patient selection. Level 3b and 4 series point to different and contradicting results, prohibiting any conclusions.
  
  
  CONCLUSIONS
  Based on the current knowLedge, LAT cannot replace surgical resection as the treatment of choice for CRLM. The increasing application of LAT in this setting is based on Level 5 evidence and is therefore inappropriate.
authors.affiliation: Division of Surgery B, The Tel-Aviv Sourasky MedicaL Center affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. benhaimm@tasmc.health.gov.il
authors.forename: Menahem
authors.initials: M
authors.lastname: Ben-Haim
authors.forename: Richard
authors.initials: R
authors.lastname: Nakache
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Klausner
mesh_terms: D015982:Bias; D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D019317:Evidence-Based Medicine; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome