Surgical resection remains the only potentially curative treatment for colorectal liver metastases (CRLM). Locoregional therapies such as transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are frequently used in patients with limited or borderline resectable liver metastases. However, radiologic response does not always indicate complete tumor eradication. A 77-year-old man with rectosigmoid junction cancer presented with synchronous liver metastases (S6, 7). Combined TACE and RFA were performed for both lesions after multidisciplinary discussion. Follow-up imaging suggested complete radiologic response, and laparoscopic low anterior resection was planned for the primary tumor. Intraoperatively, a suspicious whitish lesion was noted on the liver surface, leading to laparoscopic resection. Histopathological examination confirmed residual viable CRLM with negative margins. This case highlights the limitation of imaging-based response assessment after locoregional therapy and suggests that salvage laparoscopic hepatectomy can provide definitive oncologic management in carefully selected patients.
