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

doi:10.1016/S1470-2045(26)00143-9

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

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

This multisociety, multidisciplinary consensus-formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology-was developed to standardise the assessment of ablation margins in liver tumour thermal ablation. A modified Delphi process, consisting of two online surveys and a hybrid (online and in-person meeting in Innsbruk) consensus meeting of 72 experts from North America, South America, Europe, and Asia. Formal consensus was reached for 150 (75%) of 199 statements. Strong agreement was observed between interventional and surgical oncologists, with only 12 (6%) of 199 statements showing significantly different ratings. Participants agreed that ablation margins should be assessed and documented for every treated tumour. Margins should be assessed quantitatively in three dimensions, with contrast-enhanced CT or MRI, preferably intraprocedurally with ablation confirmation software. Ablation margins should be categorised as A0 (tumour completely covered with sufficient margin), A1 (tumour completely covered but insufficient margin), or A2 (portion of tumour remains unablated). This effort is, to our knowledge, the first international consensus initiative to define best-practice recommendations for margin assessment in liver tumour thermal ablation to standardise practices, aiming to improve and promote uniform outcomes.

Original language	English
Pages (from-to)	e248-e258
Journal	The Lancet Oncology
Volume	27
Issue number	5
Early online date	27 Apr 2026
DOIs	https://doi.org/10.1016/S1470-2045(26)00143-9
Publication status	Published - May 2026

Keywords

Ablation Techniques/standards
Consensus
Delphi Technique
Humans
Liver Neoplasms/surgery
Margins of Excision

Access to Document

10.1016/S1470-2045(26)00143-9

Embargoed Document

International multisociety Delphi consensus for liver tumour thermal ablation: margin assessment
Final published version, 2.95 MB
Licence: Taverne
Embargo ends: 27/10/2026 00:00 CET

Cite this

Paolucci, I., Overduin, C. G., Johnston, E. W., Laimer, G., Ahmed, M., Arellano, R. S., Beerman, M., Beyer, L. P., Breen, D. J., Burgmans, M. C., Calandri, M., Chern, M.-C., Crocetti, L., van Dam, R. M., Denys, A., Edwin, B., Filippiadis, D., Fong, Y., Fotiadis, N., ... Odisio, B. C. (2026). International multisociety Delphi consensus for liver tumour thermal ablation: margin assessment. The Lancet Oncology, 27(5), e248-e258. https://doi.org/10.1016/S1470-2045(26)00143-9

@article{1d580eb0924f4478aefa249ca913be22,

title = "International multisociety Delphi consensus for liver tumour thermal ablation: margin assessment",

abstract = "This multisociety, multidisciplinary consensus-formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology-was developed to standardise the assessment of ablation margins in liver tumour thermal ablation. A modified Delphi process, consisting of two online surveys and a hybrid (online and in-person meeting in Innsbruk) consensus meeting of 72 experts from North America, South America, Europe, and Asia. Formal consensus was reached for 150 (75\%) of 199 statements. Strong agreement was observed between interventional and surgical oncologists, with only 12 (6\%) of 199 statements showing significantly different ratings. Participants agreed that ablation margins should be assessed and documented for every treated tumour. Margins should be assessed quantitatively in three dimensions, with contrast-enhanced CT or MRI, preferably intraprocedurally with ablation confirmation software. Ablation margins should be categorised as A0 (tumour completely covered with sufficient margin), A1 (tumour completely covered but insufficient margin), or A2 (portion of tumour remains unablated). This effort is, to our knowledge, the first international consensus initiative to define best-practice recommendations for margin assessment in liver tumour thermal ablation to standardise practices, aiming to improve and promote uniform outcomes.",

keywords = "Ablation Techniques/standards, Consensus, Delphi Technique, Humans, Liver Neoplasms/surgery, Margins of Excision",

author = "Iwan Paolucci and Overduin, \{Christiaan G\} and Johnston, \{Edward W\} and Gregor Laimer and Muneeb Ahmed and Arellano, \{Ronald S\} and Marie Beerman and Beyer, \{Lukas P\} and Breen, \{David J\} and Burgmans, \{Mark C\} and Marco Calandri and Ming-Chih Chern and Laura Crocetti and \{van Dam\}, \{Ronald M\} and Alban Denys and Bj{\o}rn Edwin and Dimitrios Filippiadis and Yuman Fong and Nicos Fotiadis and Jacob Freedman and Fretland, \{{\AA}smund A\} and Mariano Gimenez and Garcia, \{Rodrigo G\} and Grasso, \{Rosario F\} and Helmberger, \{Thomas K\} and Pim Hendriks and Roberto Iezzi and Jenniskens, \{Sjoerd Fm\} and Alexander Kupferthaler and Anja Lachenmayer and Lee, \{Fred T\} and Lee, \{Jeong M\} and \{van der Lei\}, Susan and \{van der Leij\}, Christiaan and Ping Liang and Lin, \{Charles C-W\} and Lukas Luerken and Manuel Maglione and Andreas Mahnken and McWilliams, \{Justin P\} and Marcos Menezes and Govindarajan Narayanan and Franco Orsi and Pereira, \{Philippe L\} and Uei Pua and Puijk, \{Robbert S\} and Hyunchul Rhim and Rilling, \{William S\} and Ruiter, \{Simeon J S\} and Ryan, \{Anthony G\} and Peter Schullian and Shyn, \{Paul B\} and Siriwardena, \{Ajith K\} and Smits, \{Maarten L J\} and Sofocleous, \{Constantinos T\} and Luigi Solbiati and Vlasios Sotirchos and Stefan St{\"a}ttner and \{van Strijen\}, Marco and Trygve Syversveen and Pascale Tinguely and Lambros Tselikas and Jean-Nicolas Vauthey and Vogl, \{Thomas J\} and Wah, \{Tze M\} and White, \{Sarah B\} and Philipp Wiggermann and Wood, \{Bradford J\} and \{van der Meulen\}, Jan and Goldberg, \{S Nahum\} and Meijerink, \{Martijn R\} and Reto Bale and Odisio, \{Bruno C\}",

note = "Publisher Copyright: {\textcopyright} 2026 Elsevier Ltd.",

year = "2026",

month = may,

doi = "10.1016/S1470-2045(26)00143-9",

language = "English",

volume = "27",

pages = "e248--e258",

journal = "The Lancet Oncology",

issn = "1470-2045",

publisher = "Elsevier Limited",

number = "5",

}

Paolucci, I, Overduin, CG, Johnston, EW, Laimer, G, Ahmed, M, Arellano, RS, Beerman, M, Beyer, LP, Breen, DJ, Burgmans, MC, Calandri, M, Chern, M-C, 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, Lee, JM, van der Lei, S, van der Leij, C, Liang, P, Lin, CC-W, 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, J-N, Vogl, TJ, Wah, TM, White, SB, Wiggermann, P, Wood, BJ, van der Meulen, J, Goldberg, SN, Meijerink, MR, Bale, R & Odisio, BC 2026, 'International multisociety Delphi consensus for liver tumour thermal ablation: margin assessment', The Lancet Oncology, vol. 27, no. 5, pp. e248-e258. https://doi.org/10.1016/S1470-2045(26)00143-9

TY - JOUR

T1 - International multisociety Delphi consensus for liver tumour thermal ablation

T2 - margin assessment

AU - Paolucci, Iwan

AU - Overduin, Christiaan G

AU - Johnston, Edward W

AU - Laimer, Gregor

AU - Ahmed, Muneeb

AU - Arellano, Ronald S

AU - Beerman, Marie

AU - Beyer, Lukas P

AU - Breen, David J

AU - Burgmans, Mark C

AU - Calandri, Marco

AU - Chern, Ming-Chih

AU - Crocetti, Laura

AU - van Dam, Ronald M

AU - Denys, Alban

AU - Edwin, Bjørn

AU - Filippiadis, Dimitrios

AU - Fong, Yuman

AU - Fotiadis, Nicos

AU - Freedman, Jacob

AU - Fretland, Åsmund A

AU - Gimenez, Mariano

AU - Garcia, Rodrigo G

AU - Grasso, Rosario F

AU - Helmberger, Thomas K

AU - Hendriks, Pim

AU - Iezzi, Roberto

AU - Jenniskens, Sjoerd Fm

AU - Kupferthaler, Alexander

AU - Lachenmayer, Anja

AU - Lee, Fred T

AU - Lee, Jeong M

AU - van der Lei, Susan

AU - van der Leij, Christiaan

AU - Liang, Ping

AU - Lin, Charles C-W

AU - Luerken, Lukas

AU - Maglione, Manuel

AU - Mahnken, Andreas

AU - McWilliams, Justin P

AU - Menezes, Marcos

AU - Narayanan, Govindarajan

AU - Orsi, Franco

AU - Pereira, Philippe L

AU - Pua, Uei

AU - Puijk, Robbert S

AU - Rhim, Hyunchul

AU - Rilling, William S

AU - Ruiter, Simeon J S

AU - Ryan, Anthony G

AU - Schullian, Peter

AU - Shyn, Paul B

AU - Siriwardena, Ajith K

AU - Smits, Maarten L J

AU - Sofocleous, Constantinos T

AU - Solbiati, Luigi

AU - Sotirchos, Vlasios

AU - Stättner, Stefan

AU - van Strijen, Marco

AU - Syversveen, Trygve

AU - Tinguely, Pascale

AU - Tselikas, Lambros

AU - Vauthey, Jean-Nicolas

AU - Vogl, Thomas J

AU - Wah, Tze M

AU - White, Sarah B

AU - Wiggermann, Philipp

AU - Wood, Bradford J

AU - van der Meulen, Jan

AU - Goldberg, S Nahum

AU - Meijerink, Martijn R

AU - Bale, Reto

AU - Odisio, Bruno C

PY - 2026/5

Y1 - 2026/5

N2 - This multisociety, multidisciplinary consensus-formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology-was developed to standardise the assessment of ablation margins in liver tumour thermal ablation. A modified Delphi process, consisting of two online surveys and a hybrid (online and in-person meeting in Innsbruk) consensus meeting of 72 experts from North America, South America, Europe, and Asia. Formal consensus was reached for 150 (75%) of 199 statements. Strong agreement was observed between interventional and surgical oncologists, with only 12 (6%) of 199 statements showing significantly different ratings. Participants agreed that ablation margins should be assessed and documented for every treated tumour. Margins should be assessed quantitatively in three dimensions, with contrast-enhanced CT or MRI, preferably intraprocedurally with ablation confirmation software. Ablation margins should be categorised as A0 (tumour completely covered with sufficient margin), A1 (tumour completely covered but insufficient margin), or A2 (portion of tumour remains unablated). This effort is, to our knowledge, the first international consensus initiative to define best-practice recommendations for margin assessment in liver tumour thermal ablation to standardise practices, aiming to improve and promote uniform outcomes.

AB - This multisociety, multidisciplinary consensus-formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology-was developed to standardise the assessment of ablation margins in liver tumour thermal ablation. A modified Delphi process, consisting of two online surveys and a hybrid (online and in-person meeting in Innsbruk) consensus meeting of 72 experts from North America, South America, Europe, and Asia. Formal consensus was reached for 150 (75%) of 199 statements. Strong agreement was observed between interventional and surgical oncologists, with only 12 (6%) of 199 statements showing significantly different ratings. Participants agreed that ablation margins should be assessed and documented for every treated tumour. Margins should be assessed quantitatively in three dimensions, with contrast-enhanced CT or MRI, preferably intraprocedurally with ablation confirmation software. Ablation margins should be categorised as A0 (tumour completely covered with sufficient margin), A1 (tumour completely covered but insufficient margin), or A2 (portion of tumour remains unablated). This effort is, to our knowledge, the first international consensus initiative to define best-practice recommendations for margin assessment in liver tumour thermal ablation to standardise practices, aiming to improve and promote uniform outcomes.

KW - Ablation Techniques/standards

KW - Consensus

KW - Delphi Technique

KW - Humans

KW - Liver Neoplasms/surgery

KW - Margins of Excision

U2 - 10.1016/S1470-2045(26)00143-9

DO - 10.1016/S1470-2045(26)00143-9

M3 - Review article

C2 - 42061382

SN - 1470-2045

VL - 27

SP - e248-e258

JO - The Lancet Oncology

JF - The Lancet Oncology

IS - 5

ER -

International multisociety Delphi consensus for liver tumour thermal ablation: margin assessment

Abstract

Keywords

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