Faculty Collaboration Database

International multisociety Delphi consensus for liver tumour thermal ablation: procedural and practice standards. Lancet Oncol 2026 May;27(5):e259-e270

Date

05/01/2026

Pubmed ID

42061383

DOI

10.1016/S1470-2045(26)00114-2

Scopus ID

2-s2.0-105036802707 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

Thermal ablation offers a safer, less invasive, and more cost-effective curative-intent treatment for selected patients with primary and metastatic liver tumours than surgery; when done with appropriate technique, ablation can deliver similar oncological outcomes. However, effectiveness in routine practice varies because structured training, planning, and procedural governance remain scarce. These international multidisciplinary, multi-society guidelines-formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology-define key domains contributing to procedural difficulty and practice variation in liver tumour thermal ablation. A Delphi consensus initiative held in Innsbruck, Austria, engaged 72 experts across three iterative rounds of scoring across 135 statements grouped into five domains: credentialing, indications, approach, procedural factors, and safety measures. Consensus was achieved for 94 (70%) of 135 statements. The least invasive route-typically percutaneous-should be prioritised, and margin adequacy was reaffirmed as the principal technical goal. Procedural difficulty was considered context-dependent, shaped by tumour factors, institutional infrastructure, and operator experience. Organ displacement techniques were endorsed to maintain safety and expand treatable indications. Complex ablations should be done by experienced operators (more than 100 previous cases), with programmes underpinned by structured training, multidisciplinary team participation, and routine audit. Future efforts should develop and validate practical tools such as difficulty scoring systems, standardised procedural reporting templates, and comprehensive training curricula to improve consistency, standardisation, and clinical outcomes globally.

Author List

Laimer G, Johnston EW, Overduin CG, Paolucci I, Ahmed M, Arellano RS, Beermann M, Beyer LP, Breen DJ, Burgmans MC, Calandri M, Chern MC, Crocetti L, van Dam RM, Denys A, Edwin B, Filippiadis D, Fong Y, Fotiadis N, Freedman J, Fretland ÅA, Gimenez M, Garcia RG, Grasso RF, Helmberger TK, Hendriks P, Iezzi R, Jenniskens SF, Kupferthaler A, Lachenmayer A, Lee FT Jr, Lee JM, van der Lei S, van der Leij C, Liang P, Lin CC, Luerken L, Maglione M, Mahnken A, McWilliams JP, Menezes M, Narayanan G, Orsi F, Pereira PL, Pua U, Puijk RS, Rhim H, Rilling WS, Ruiter SJS, Ryan AG, Schullian P, Shyn PB, Siriwardena AK, Smits MLJ, Sofocleous CT, Solbiati L, Sotirchos V, Stättner S, van Strijen M, Syversveen T, Tinguely P, Tselikas L, Vauthey JN, Vogl TJ, Wah TM, White SB, Wiggermann P, Wood BJ, van der Meulen J, Goldberg SN, Meijerink MR, Odisio BC, Bale R

Authors

William S. Rilling MD Vice Chair, Professor in the Radiology department at Medical College of Wisconsin
Sarah B. White MS, MD Associate Dean, Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Ablation Techniques
Catheter Ablation
Delphi Technique
Humans
Liver Neoplasms