Background: Thermal ablation is an accepted treatment modality for small and central liver tumors. In extensive colorectal liver metastatic disease (CRLM), hepatectomy can be combined with ablation, resulting in a parenchymal-sparing strategy. This may increase salvageability rates in case of recurrence.Methods: All patients with advanced CRLM that underwent combined ablation and resection between April 2012 and April 2021, were retrospectively analyzed from a prospectively maintained database. Primary endpoints include postoperative 30-day morbidity and ablation-site recurrence (ASR). The surgical approaches were compared. Ablated lesions were screened for ASR on postoperative follow-up imaging.Results: Of 54 patients that underwent combined ablation and resection, 32 (59.3%) were performed through a minimally invasive approach. Eleven (20.4%) were minor resections, 32 (59.3%) were technically major and 11 (20.4%) were anatomically major resections. Twelve complications occurred (22.2%), among which 2 (3.8%) major complications (Clavien-Dindo ≥ IIIa). Ninety-day mortality rate was 1.9%. Out of 82 ablated lesions, 6 ASRs (11.1%) occurred. Median blood loss was significantly lower in the minimally invasive group, compared with open [90 mL (32.5 to 200) vs. 200 mL (100 to 400), P = 0.005]. Pringle maneuver was significantly performed less in the minimally invasive group [8 (25.0%) vs. 16 (72.7%), P = 0.001], but took more time [36.1 min ( ± 15.6) vs. 21.6 ( ± 9.9); P = 0.011]. Short-term (1 y) overall and disease-free survival were respectively 81.4% and 50.0%. Conclusion:Combining microwave ablation and liver resection is a feasible and safe parenchymal-sparing technique, through both minimally invasive and open approach for treating extended CRLM disease. It has a low ablation-related complication rate and acceptable ablation-site recurrence rate.

Teaching Point: Synthetic CT images can improve evaluation of bony lesions on MRI and show potential for fracture evaluation, but validation is needed.

Teaching Point: Caseous calcification of the mitral annulus is a benign mass-like lesion which can mimic cardiac tumor or abscess; therefore, multimodal imaging should be considered, avoiding unnecessary interventions.

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Teaching point: Cortical metastasis has to be considered in older patients with a cortical osteolytic lesion.