Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection
2.3. Data Extraction and Statistical Analysis
2.4. Data Analysis
2.5. Quality Assessment
3. Results
3.1. Study Selection
3.2. Quality Assessment Results
3.3. Study Characteristics
3.4. Simultaneous Resection vs. Classic Staged (“Bowel-First”) Resection
3.5. Simultaneous Resection vs. “Liver-First” Surgery
3.6. Liver-First Surgery vs. Bowel-First Surgery
3.7. Anatomic vs. Non-Anatomic Surgery
4. Discussion
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Author, Year | Primary Studies Design (n) | Purpose | N° of Patients (n) | Condition | Comparison | Outcome (n Studies) | Metrics [95% CI] | p-Value | I2 (%) | Quality |
---|---|---|---|---|---|---|---|---|---|---|
Hillingsø JG, 2008 [12] | R (16) | To determine the level of evidence for recommendations of a treatment strategy of synchronous liver metastases from colorectal cancer | 1650 | Synchronous CRLM | Simultaneous vs. staged surgery | 5-year OS (11) | OR: 0.90 [0.66,1.24] | 0.14 | 24 | Critically low |
Chen J, 2011 [13] | R (14) | To compare outcomes between simultaneous resection and staged resection from all published comparative studies in the literature | 2204 | Synchronous CRLM | Simultaneous vs. staged surgery | 5-year OS (10) | OR: 1.14 [0.86,1.50] | 0.37 | 0 | Critically low |
Sui CJ, 2012 [14] | R (7) | To compare anatomic resection versus non-anatomic resection for colorectal liver metastases with respect to perioperative and oncological outcomes | 1662 | CRLM | Anatomic vs. non-anatomic resection | 5-year DFS (2) | OR: 1.27 [0.66,2.42] | 0.47 | 61.5 | Critically low |
Li ZQ, 2013 [15] | R (19) | To identify the optimal timing of surgical resection for colon and liver in CRLM patients | 2724 | Synchronous CRLM | Simultaneous vs. staged surgery | 5-year OS (13) | OR: 1.12 [0.88,1.42] | 0.38 | 0 | Critically low |
5-year DFS (3) | OR: 0.61 [0.33,1.13] | 0.12 | 0 | |||||||
Yin Z, 2013 [16] | R (17) | To define the safety and efficacy of simultaneous versus delayed resection of the colon and liver in CRLM patients | 2880 | Synchronous CRLM | Simultaneous vs. staged surgery | DFS (4) | HR: 1.04 [0.76,1.43] | 0.79 | 53 | Critically low |
OS (10) | HR: 0.96 [0.81,1.14] | 0.64 | 0 | |||||||
Bijukchhe SM, 2014 [17] | R (20) | To evaluate the efficacy between simultaneous resection and staged resection in patients with CRLM | 3194 | Synchronous CRLM | Simultaneous vs. staged surgery | 5-year OS (12) | OR: 1.08 [0.84,1.38] | 0.54 | 0 | Critically low |
5-year DFS (4) | OR: 0.60 [0.34,1.04] | 0.07 | 0 | |||||||
Feng Q, 2014 [18] | R (22) | To compare simultaneous resection with staged strategy in colorectal cancer for patients with synchronous liver metastases patients, balancing baseline characteristics | 4494 | Synchronous CRLM | Simultaneous vs. staged surgery | OS (15) | HR: 0.96 [0.86,1.08] | 0.50 | 0 | Low |
DFS (6) | HR: 0.97 [0.64,1.47] | 0.87 | 76 | |||||||
Kelly ME, 2014 [19] | R (18) | To compare the short- and long-term outcomes for the classical colorectal-first, the liver-first, and the combined resections approaches | 3605 | Synchronous CRLM | Simultaneous vs. liver first | 5-year OS (3) | OR: 0.78 [0.44,1.40] | 0.410 | 0 | Critically low |
Bowel first vs. liver first | 5-year OS (4) | OR: 0.85 [0.59,1.22] | 0.374 | 69.8 | ||||||
Bowel first vs. simultaneous | 5-year OS (14) | OR: 0.99 [0.83,1.19] | 0.927 | 5.3 | ||||||
Tang H, 2016 [20] | R (21) | To compare the efficacy of anatomic resection procedure and non-anatomic procedure for CRLM | 5207 | CRLM | Anatomic vs. non-anatomic resection | OS (12) | HR: 1.06 [0.95,1.18] | 0.18 | 27.3 | Critically low |
DFS (5) | HR: 1.11 [0.99,1.24] | 0.76 | 0 | |||||||
Gavriilidis P, 2018 [21] | R (30) | To assess outcomes between patients undergoing simultaneous or delayed hepatectomy for synchronous colorectal liver metastases | 5300 | Synchronous CRLM | Simultaneous vs. staged surgery | OS (17) | HR: 0.97 [0.88,1.08] | 0.601 | 0 | Critically low |
Deng G, 2019 [22] | R (17) P (1) | To assess the safety and efficacy of parenchymal-sparing hepatectomy as a treatment of colorectal liver metastases | 7081 | CRLM | Anatomic vs. non-anatomic resection | OS (16) | HR: 1.01 [0.94,1.08] | 0.82 | 0 | Critically low |
DFS (11) | HR: 1.00 [0.94,1.07] | 0.92 | 0 | |||||||
Ghiasloo M, 2020 [23] | R (43) P (1) | To compare the bowel-first approach, simultaneous resection, and the liver-first approach for patients with colorectal cancer with synchronous liver metastases | 10,848 | Synchronous CRLM | Liver first vs. bowel first | 5-year DFS | OR: 0.57 [0.16,2.06] | 0.39 | 91 | Critically low |
5-year OS | OR: 0.88 [0.54,1.44] | 0.61 | 44 | |||||||
Simultaneous vs. bowel first | 5-year DFS | OR: 1.07 [0.71,1.62] | 0.74 | 31 | ||||||
5-year OS | OR: 0.90 [0.75,1.08] | 0.26 | 14 | |||||||
Simultaneous vs. Liver first | 5-year OS | OR: 0.47 [0.25,0.90] | 0.02 | 0 | ||||||
Hajibandeh S, 2020 [4] | R (41) | To evaluate the comparative outcomes and clinical characteristics of simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases | 12,081 | Synchronous CRLM | Simultaneous vs. staged surgery | 5-year OS (23) | OR: 0.88 [0.73,1.07] | 0.19 | 45 | Critically low |
Magouliotis DE, 2020 [24] | R (8) P (2) | To compare the perioperative outcomes of liver-first and classical strategy for the management of synchronous colorectal liver metastases | 3656 | Synchronous CRLM | Bowel first vs. Liver first | 5-year DFS (4) | OR: 1.25 [0.78,1.99] | 0.36 | 9 | Critically low |
5-year OS (6) | OR: 1.23 [0.75,2.03] | 0.42 | 66 | |||||||
Liu J, 2022 [25] | R (17) P (1) | To compare the difference between patients with CRLM who underwent simultaneous resection and staged resection, especially during major hepatectomy (≥3 liver segments) | 5101 | Synchronous CRLM | Simultaneous vs. staged surgery | 5-year mortality (13) | OR: 1.08 [0.93,1.25] | 0.337 | 33.5 | Critically low |
Wang SH, 2022 [26] | R (22) RCT (1) | To evaluate the safety and long-term prognoses of simultaneous and staged resection of CRLM | 4862 | Synchronous CRLM | Simultaneous vs. staged surgery | 5-year DFS (4) | HR: 1.26 [0.96,1.66] | 0.098 | 18.1 | Critically low |
5-year OS (10) | HR: 1.13 [0.95,1.34] | 0.164 | 34.6 | |||||||
Wang K, 2023 [27] | R (22) | To evaluate the safety and efficacy of parenchymal-sparing resection over anatomic resection for colorectal liver metastases | 7228 | CRLM | Anatomic vs. non-anatomic resection | OS (22) | HR: 1.08 [0.95,1.22] | 0.245 | 49.3 | Critically low |
DFS (14) | HR: 0.84 [0.41,1.73] | 0.259 | 75.1 |
Parameter | Meta-Analyses Included (n) | Primary Studies Included (n) | Patients in the First Group (n) | Patients in the Second Group (n) | Metrics [95% CI] Recalculated | p-Value | I2 (%) |
---|---|---|---|---|---|---|---|
Simultaneous resection vs. “bowel-first” resection | |||||||
OS | 4 | 23 | 1750 | 2242 | HR: 0.96 [0.88, 1.05] | 0.40 | 0 |
DFS | 2 | 7 | 544 | 397 | HR: 0.95 [0.67, 1.35] | 0.79 | 72 |
5-y OS | 9 | 38 | 3774 | 6211 | OR: 1.05 [0.86, 1.27] | 0.64 | 70 |
5-y DFS | 4 | 5 | 245 | 275 | OR: 0.94 [0.60, 1.47] | 0.78 | 47 |
Perioperative mortality | 10 | 21 | 2259 | 3842 | RR: 1.88 [1.33, 2.65] | <0.001 | 11 |
Postoperative complications | 9 | 44 | 4486 | 5415 | RR: 0.98 [0.90, 1.07] | 0.71 | 50 |
Recurrence | 3 | 14 | 1318 | 1455 | RR: 1.04 [0.91, 1.19] | 0.56 | 62 |
Blood loss, ml | 5 | 9 | 642 | 1261 | SMD: −0.35 [−0.92, 0.23] | 0.24 | 97 |
Perioperative blood transfusion | 1 | 9 | 616 | 1213 | RR: 1.11 [0.96, 1.30] | 0.17 | 40 |
Hospitalization, days | 8 | 26 | 3233 | 3137 | SMD: −1.08 [−1.55, −0.60] | <0.001 | 98 |
Operative time, min | 4 | 13 | 923 | 950 | SMD: −0.58 [−1.10, −0.07] | 0.03 | 96 |
Simultaneous resection vs. “liver-first” resection | |||||||
5-y OS | 2 | 3 | 88 | 86 | OR: 0.47 [0.25, 0.90] | 0.02 | 0 |
“Liver-first” vs. “bowel-first” resection | |||||||
5-y OS | 3 | 8 | 525 | 1783 | OR: 1.15 [0.93, 1.42] | 0.19 | 18 |
5-y DFS | 3 | 5 | 232 | 1305 | OR: 1.01 [0.72, 1.42] | 0.96 | 0 |
Parameter | Meta-Analyses Included (n) | Primary Studies Included (n) | Patients Undergoing Anatomic Resection (n) | Patients Undergoing Non-Anatomic Resection (n) | Metrics [95% CI] Recalculated | p-Value | I2 (%) |
---|---|---|---|---|---|---|---|
OS | 4 | 27 | 3368 | 4399 | HR: 1.04 [0.98, 1.11] | 0.16 | 31 |
DFS | 4 | 17 | 2660 | 3763 | HR: 1.08 [0.97, 1.20] | 0.17 | 59 |
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Milazzo, M.; Todeschini, L.; Caimano, M.; Mattia, A.; Cristin, L.; Martinino, A.; Bianco, G.; Spoletini, G.; Giovinazzo, F. Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review. Cancers 2024, 16, 1849. https://doi.org/10.3390/cancers16101849
Milazzo M, Todeschini L, Caimano M, Mattia A, Cristin L, Martinino A, Bianco G, Spoletini G, Giovinazzo F. Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review. Cancers. 2024; 16(10):1849. https://doi.org/10.3390/cancers16101849
Chicago/Turabian StyleMilazzo, Martina, Letizia Todeschini, Miriam Caimano, Amelia Mattia, Luca Cristin, Alessandro Martinino, Giuseppe Bianco, Gabriele Spoletini, and Francesco Giovinazzo. 2024. "Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review" Cancers 16, no. 10: 1849. https://doi.org/10.3390/cancers16101849