Renal replacement therapy (RRT) is frequently used in critically ill patients with acute kidney injury (AKI). Here, we provide guidelines for the management of RRT in critically ill patients on the intensive care unit (ICU). We convened a systemic literature research and a Delphi process with a bi-national multidisciplinary consensus panel including 22 clinicians of 12 different German-speaking societies (Germany and Austria) with expertise in RRT. This structured guideline process was the basis for the evidence-based statements and recommendations. We identified seven clinical areas needing guidance: (1) start, (2) modality (diffusion and convection), (3) continuous/ intermittent, (4) anticoagulation, (5) dose (6) pharmacotherapy, (7) stopping criteria. The consensus produced 73 statements and recommendations regarding key clinical areas, the most important 47 statements and recommendations are summarized in this overview. This evidence-based bi-national guideline should provide physicians with guidance for delivering best practice to critically ill patients with a dialysis-dependent AKI.
Purpose:Primary resection of liver metastases in colorectal cancer remains the leading curative approach. However, a small future liver remnant or central localization of metastases often prevent resectability. In such cases, combining resection with percutaneous ablation may offer a curative-intent treatment option. This study aims to evaluate the oncologic results and morbidity of this combined treatment. Materials and methods:In this retrospective study, 21 patients with advanced colorectal liver metastases underwent a two-stage treatment consisting of planned incomplete resection and percutaneous ablation. Outcomes assessed included overall survival and intrahepatic progression-free survival. Main exclusion criteria were extrahepatic disease and ablation of metastases > 3 cm. Results are reported as medians with 95% confidence intervals and standard deviation. Results:The median number of preoperative intrahepatic metastases was 5 [2-13]. Follow-up was available for 95% of patients, with a median follow-up of 21 months. Intra- und extrahepatic recurrences occurred in 81% (17/21). Median intrahepatic progression-free survival was 5 [0-44] months. Median overall survival was 36.5 [6.6-55] months, resulting in a 1-year survival rate of 91%. Twelve patients (57%) passed away. Technical success was achieved in 90%. Three major complications occurred, all of which were successfully treated. Conclusion:In patients with partially unresectable colorectal liver metastases, a two-stage approach combining resection and percutaneous ablation represents a potential curative-intent strategy, particularly when intraoperative ablation is not feasible. Despite high recurrence rates, OS was comparatively long relative to systemic therapy. Further studies are needed to explore treatment sequencing, perioperative therapies, and advanced ablation technologies for optimizing the concept. Ultimately, treatment must be individualized based on the patient's disease profile and institutional capabilities. Key Points:· A two-stage approach combining resection and percutaneous ablation represents a potential curative-intent strategy in partially irresectable colorectal liver metastases.. · High recurrence rates occur, but overall survival remains comparatively long.. · Individualized, interdisciplinary treatment planning optimizes patient outcomes.. · Further research is needed on sequencing, perioperative strategies, and ablation technologies.. Citation Format:· Lokancevic T, Keil S, Bruners P et al. Treatment of Irresectable Colorectal Liver Metastases by Combination of Liver Resection and Percutaneous Tumor Ablation: Mid-term Outcome. Rofo 2026; DOI 10.1055/a-2781-8926.
