Path forward: Cryoablation for colorectal liver metastases.

[PURPOSE] Colorectal liver metastases (CRLM) are a leading cause of mortality in patients with colorectal cancer. While surgical resection is the standard curative option, most patients are ineligible. Consequently, cryoablation (CA) has emerged as a potential alternative. This review aims to summarise the technical characteristics, clinical outcomes, immunomodulatory effects, and current combination strategies of CA for CRLM, and to highlight future research directions.

[METHODS] This narrative review was informed by a structured literature search in PubMed and Embase (January 2000 - October 2025). Studies reporting clinical outcomes, mechanistic data, or both for CA in hepatic tumours, with a focus on CRLM, were included. Exclusions comprised studies with inseparable liver-specific data, non-hepatic sites, paediatric populations, and case series with fewer than 5 patients.

[RESULTS] CA offers a locoregional treatment option that can achieve meaningful local tumour control in carefully selected patients, particularly those with liver-dominant, small-volume disease and preserved liver function. Mechanistically, CA exerts dualistic immunomodulatory effects: while it induces immunogenic cell death, it simultaneously triggers immunosuppressive pathways, in particular neutrophil extracellular trap formation. Accumulating evidence suggests that combining CA with chemotherapy, targeted agents, immune checkpoint inhibitors, or surgical resection may enhance anti-tumour effects, although high-level evidence remains limited. Notably, quantitative margin assessment using advanced imaging and artificial intelligence is emerging as a promising tool for predicting local control and optimising outcomes.

[CONCLUSION] CA serves as a valuable therapeutic option for CRLM. Broader clinical application requires precision ablation with verified margins, technical optimisation for larger and perivascular lesions, biomarker-guided strategies supported by multi-omics, and robust multidisciplinary tumour board decision-making to standardise indications.