International multisociety Delphi consensus for liver tumour thermal ablation: procedural and practice standards - 28/04/26
Doi : 10.1016/S1470-2045(26)00114-2
Gregor Laimer, MD PhD a, *, Edward W Johnston, MD b, c, *, Christiaan G Overduin, PhD d, Iwan Paolucci, PhD e, Muneeb Ahmed, ProfMD f, Ronald S Arellano, ProfMD g, Marie Beermann, MD h, Lukas P Beyer, ProfMD i, David J Breen, MD j, Mark C Burgmans, ProfMD k, Marco Calandri, ProfMD l, m, Ming-Chih Chern, MD n, Laura Crocetti, MD PhD o, Ronald M van Dam, MD PhD p, q, r, Alban Denys, Prof s, Bjørn Edwin, ProfMD PhD t, Dimitrios Filippiadis, ProfMD u, Yuman Fong, ProfMD v, Nicos Fotiadis, ProfMD b, c, w, Jacob Freedman, MD x, Åsmund A Fretland, MD t, Mariano Gimenez, ProfMD y, Rodrigo G Garcia, MD z, Rosario F Grasso, ProfMD aa, Thomas K Helmberger, ProfMD ab, Pim Hendriks, MSc k, Roberto Iezzi, ProfMD ac, Sjoerd FM Jenniskens, MD d, Alexander Kupferthaler, MD ad, Anja Lachenmayer, MD ae, Fred T Lee, ProfMD af, Jeong M Lee, ProfMD ag, Susan van der Lei, MD ah, Christiaan van der Leij, MD ai, aj, Ping Liang, ProfMD ak, Charles C-W Lin, MD al, Lukas Luerken, MD am, Manuel Maglione, MD an, Andreas Mahnken, ProfMD ao, Justin P McWilliams, ProfMD ap, Marcos Menezes, ProfMD aq, Govindarajan Narayanan, ProfMD ar, Franco Orsi, ProfMD as, Philippe L Pereira, ProfMD at, Uei Pua, ProfMD au, Robbert S Puijk, MD ah, Hyunchul Rhim, ProfMD av, William S Rilling, ProfMD aw, Simeon J S Ruiter, MSc ax, Anthony G Ryan, MD ay, az, ba, Peter Schullian, MD a, Paul B Shyn, MD bb, Ajith K Siriwardena, ProfMD bc, Maarten L J Smits, MD bd, Constantinos T Sofocleous, ProfMD be, Luigi Solbiati, ProfMD bf, Vlasios Sotirchos, MD be, Stefan Stättner, MD bg, bh, Marco van Strijen, MD bi, Trygve Syversveen, MD bj, Pascale Tinguely, MD bk, Lambros Tselikas, MD bl, Jean-Nicolas Vauthey, ProfMD bm, Thomas J Vogl, ProfMD bn, Tze M Wah, ProfMD bo, Sarah B White, ProfMD aw, Philipp Wiggermann, MD bp, Bradford J Wood, ProfMD bq, Jan van der Meulen, ProfPhD br, S Nahum Goldberg, ProfMD bs, Martijn R Meijerink, ProfMD ah, Bruno C Odisio, ProfMD e, †, Reto Bale, ProfMD a, †, ⁎ 
a Department of Radiology, Interventional Oncology-Stereotaxy and Robotics, Medical University Innsbruck, Tirol-Kliniken, Innsbruck, Austria
b Department of Interventional Radiology, Royal Marsden Hospital NHS Foundation Trust, London, UK
c Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
d Department of Medical Imaging, Interventional Radiology, Radboud University Medical Center, Nijmegen, Netherlands
e Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
f Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
g Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
h Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
i Department of Radiology, University Hospital Regensburg & Klinikum Ernst von Bergmann, Potsdam, Germany
j Department of Radiology, University Hospital Southampton, Southampton, UK
k Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
l Department of Surgical Sciences, University of Torino, Turin, Italy
m Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
n Department of Radiology, Show-Chwan Memorial Hospital, Changhua, Taiwan
o Department of Division of Interventional Radiology, University of Pisa-Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
p Department of Hepato-Pancreato-Biliary Surgery and Surgical Oncology, Maastricht University Medical Center & GROW Research Institute for Oncology and Reproduction, Maastricht, Netherlands
q Centre Hospitalier Universitaire de Liege, Liege, Belgium
r Universitätsklinikum Essen, Essen, Germany
s Department of Radiology and Interventional Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
t The Intervention Centre, and Department of HPB Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
u 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, Athens, Greece
v Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
w Department of Interventional Radiology, The Royal Marsden NHS Foundation Trust, Institute of Cancer Research, London, UK
x Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
y Department of IGS and Percutaneous Surgery, IRCAD University, Strasbourg, France
z Department of Interventional Medicine, Einstein Hospital Israelita, São Paulo, Brazil
aa Department of Diagnostic & Interventional Radiology, Università Campus Bio-Medico, Policlinico Universitario Campus Bio-Medico, Rome, Italy
ab Department of Diagnostic and Interventional Radiology and Nuclear Medicine, München Klinik Bogenhausen, Munich, Germany
ac Diagnostic Imaging and Oncologic Radiotherapy, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
ad Division of Interventional Radiology, Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
ae Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
af Department of Radiology, Biomedical Engineering, and Urology, University of Wisconsin-Madison, Madison, WI, USA
ag Department of Radiology, Seoul National University Hospital, Seoul, South Korea
ah Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
ai Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
aj GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
ak Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
al Department of Surgery, Show-Chwan Memorial Hospital, Changhua, Taiwan
am Department of Radiology, University Hospital Regensburg, Germany
an Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Austria
ao Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St Josef-Hospital, University Hospital, Ruhr University Bochum, Bochum, Germany
ap Department of Radiology, David Geffen School of Medicine UCLA Health System, Los Angeles, CA, USA
aq Department of Radiology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
ar Department of Interventional Radiology, Miami Cancer Institute, Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
as Department of Interventional Radiology, IRCCS European Institute of Oncology, Milan, Italy
at Department of Radiology, Minimally Invasive Therapies & Nuclear Medicine, SLK-Clinics Heilbronn, Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
au Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
av Department of Radiology, Samsung Medical Center, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
aw Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
ax Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, Netherlands
ay Division of Interventional Radiology, Department of Radiology, University Hospital Waterford, Waterford City, Ireland
az Royal College of Surgeons in Ireland, Dublin, Ireland
ba University College Cork, Cork, Ireland
bb Department of Abdominal Imaging & Intervention, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
bc Department of Hepato-Pancreato-Biliary Surgery, Manchester Royal Infirmary, Manchester, UK
bd Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
be Weil-Cornell Medical College Interventional Oncology/Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
bf IRCCS Humanitas Clinical and Research Hospital & Humanitas University, Rozzano, Milan, Italy
bg Department of General, Visceral & Vascular Surgery, Kepler University Hospital, Linz, Austria
bh Clinical Research Institute for Inflammation Medicine, Medical Faculty, Johannes Kepler University, Linz, Austria
bi Department of Radiology, St Antonius Hospital, Nieuwegein, Netherlands
bj Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
bk Department of Visceral Surgery and Transplantation, University Hospital Zürich, University of Zurich, Zürich, Switzerland
bl Department of Interventional Radiology, Gustave Roussy Cancer Center, Villejuif, France
bm Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
bn Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
bo Department of Diagnostic & Interventional Radiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
bp Department of Radiology and Nuclear Medicine, Städtisches Klinikum Braunschweig, Braunschweig, Germany
bq Department of Radiology and Imaging Science, National Institutes of Health Clinical Center, Bethesda, MD, USA
br Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
bs Department of Radiology, Image-guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
* Correspondence to: Prof Reto Bale, Department of Radiology, Interventional Oncology-Stereotaxy and Robotics, Medical University Innsbruck, Tirol-Kliniken, Innsbruck 6020, Austria Department of Radiology Interventional Oncology-Stereotaxy and Robotics Medical University Innsbruck Tirol-Kliniken Innsbruck 6020 Austria
Summary |
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.
Le texte complet de cet article est disponible en PDF.Plan
© 2026
Elsevier Ltd. Tous droits réservés.
Vol 27 - N° 5
P. e259-e270 - mai 2026 Retour au numéro
Article précédent
- International multisociety Delphi consensus for liver tumour thermal ablation: margin assessment
- Iwan Paolucci, Christiaan G Overduin, Edward W Johnston, Gregor Laimer, Muneeb Ahmed, Ronald S Arellano, Marie Beerman, Lukas P Beyer, David J Breen, Mark C Burgmans, Marco Calandri, Ming-Chih Chern, Laura Crocetti, Ronald M van Dam, Alban Denys, Bjørn Edwin, Dimitrios Filippiadis, Yuman Fong, Nicos Fotiadis, Jacob Freedman, Åsmund A Fretland, Mariano Gimenez, Rodrigo G Garcia, Rosario F Grasso, Thomas K Helmberger, Pim Hendriks, Roberto Iezzi, Sjoerd FM Jenniskens, Alexander Kupferthaler, Anja Lachenmayer, Fred T Lee, Jeong M Lee, Susan van der Lei, Christiaan van der Leij, Ping Liang, Charles C-W Lin, Lukas Luerken, Manuel Maglione, Andreas Mahnken, Justin P McWilliams, Marcos Menezes, Govindarajan Narayanan, Franco Orsi, Philippe L Pereira, Uei Pua, Robbert S Puijk, Hyunchul Rhim, William S Rilling, Simeon J S Ruiter, Anthony G Ryan, Peter Schullian, Paul B Shyn, Ajith K Siriwardena, Maarten L J Smits, Constantinos T Sofocleous, Luigi Solbiati, Vlasios Sotirchos, Stefan Stättner, Marco van Strijen, Trygve Syversveen, Pascale Tinguely, Lambros Tselikas, Jean-Nicolas Vauthey, Thomas J Vogl, Tze M Wah, Sarah B White, Philipp Wiggermann, Bradford J Wood, Jan van der Meulen, S Nahum Goldberg, Martijn R Meijerink, Reto Bale, Bruno C Odisio
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?