Neoadjuvant chemotherapy versus upfront surgery for resectable colorectal liver metastases: A systemic review and meta-analysis

IF 0.3 4区医学 Q4 SURGERY

Surgical Practice Pub Date : 2023-10-12 DOI:10.1111/1744-1633.12662

Pipit Burasakarn MD, PhD, Sermsak Hongjinda MD, Pusit Fuengfoo MD, Anuparp Thienhiran MD

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引用次数: 0

Abstract

Aim

To compare the differences between neoadjuvant chemotherapy with resection and upfront surgery for patients with resectable colorectal cancer with liver metastases.

Patients and Methods

The following electronic databases were searched for systematic literature: PubMed, Cochrane Library and Google Scholar. Studies fulfilling the following criteria were included in the analysis: compared neoadjuvant chemotherapy and upfront surgery; included patients with resectable metastases at the time of presentation; reported the long-term results, including overall survival (OS) and disease-free survival (DFS); and identified early adverse postoperative events, including 30-day mortality and overall postoperative complications.

Results

Over 24 studies with 8700 patients were analysed. Patients were divided into the neoadjuvant chemotherapy group (n = 3490, 40.1%) and the upfront surgery group (n = 5172, 59.4%). The meta-analysis showed no statistically significant difference in terms of overall morbidities [odds ratio (OR) 1.19, 95% confidence interval (CI) 0.84-1.67] and mortality (OR 1.48, 95% CI 0.75-2.92) between the neoadjuvant chemotherapy and upfront surgery groups. However, the meta-analysis showed a favourable OS in the upfront surgery group (OR 1.21, 95% CI 1.06-1.38) and favourable DFS in the upfront surgery group (OR 1.71, 95% CI 1.38-2.12), including the subgroups of 1-, 3-, 5-year DFS (OR 1.38, 95% CI 1.06-1.8; OR 2.06, 95% CI 1.35-3.14 and OR 1.65, 95% CI 1.18-2.29, respectively).

Conclusion

Neoadjuvant chemotherapy has no benefit for resectable colorectal cancer with liver metastases; therefore, upfront surgery should be considered as the treatment of choice.

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新辅助化疗与先期手术治疗可切除的结直肠肝转移瘤：系统回顾和荟萃分析

目的比较对可切除并伴有肝转移的结直肠癌患者进行新辅助化疗和切除术与先期手术的差异。患者和方法在以下电子数据库中搜索系统性文献：PubMed、Cochrane Library 和 Google Scholar。符合以下标准的研究均纳入分析：比较了新辅助化疗和前期手术；纳入了发病时有可切除转移灶的患者；报告了长期结果，包括总生存期（OS）和无病生存期（DFS）；确定了术后早期不良事件，包括 30 天死亡率和术后总并发症。结果对超过 24 项研究的 8700 名患者进行了分析。患者分为新辅助化疗组（3490 人，40.1%）和前期手术组（5172 人，59.4%）。荟萃分析表明，新辅助化疗组和前期手术组在总发病率[几率比（OR）1.19，95% 置信区间（CI）0.84-1.67]和死亡率（OR 1.48，95% CI 0.75-2.92）方面没有明显的统计学差异。然而，荟萃分析显示，前期手术组的OS（OR 1.21，95% CI 1.06-1.38）和DFS（OR 1.71，95% CI 1.38-2.12）均优于新辅助化疗组，包括1年、3年和5年DFS亚组（分别为OR 1.38，95% CI 1.06-1.8；OR 2.06，95% CI 1.35-3.14和OR 1.65，95% CI 1.18-2.29）。结论新辅助化疗对肝转移的可切除结直肠癌没有益处，因此应将前期手术作为首选治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Practice 医学-外科

CiteScore

0.90

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Surgical Practice is a peer-reviewed quarterly journal, which is dedicated to the art and science of advances in clinical practice and research in surgery. Surgical Practice publishes papers in all fields of surgery and surgery-related disciplines. It consists of sections of history, leading articles, reviews, original papers, discussion papers, education, case reports, short notes on surgical techniques and letters to the Editor.