Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-11-06 DOI:10.1016/j.hpb.2024.10.010

Jasper P Sijberden, Maria S Alvarez Escribano, Meidai Kasai, Carlotta Ferretti, Paola Cesaro, Claudio Bnà, Alberto Zaniboni, Ajith K Siriwardena, Pieter J Tanis, Mohammed Abu Hilal

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引用次数: 0

Abstract

Background: Previous meta-analyses have yielded conflicting results on the optimal surgical treatment strategy in patients with synchronous colorectal liver metastases (sCRLM). This network meta-analysis aims to provide an overview on colorectal-, liver first and simultaneous resections to treat sCRLM.

Methods: A search was conducted in MEDLINE, Embase and Cochrane CENTRAL (inception-July 11,2023). Pairwise and network meta-analyses were conducted to compare the three strategies, using colorectal-first resections as reference group.

Results: Overall, 46 studies with a total of 20,991 patients were included, a significant portion at a high risk of bias. Simultaneous resections were associated with less blood loss (MD -145.44 ml, 95%CI -239.40 to -51.48) and shorter hospital stays (MD -6.39 days, 95%CI -7.78 to -4.99). Liver-first resections were associated with more transfusions (OR 1.89, 95%CI 1.04 to 3.42) and shorter hospital stays (MD -4.53 days, 95%CI -7.99 to -1.06). Simultaneous resections were associated with less incomplete macroscopic disease clearances (OR 0.33, 95%CI 0.12 to 0.92), while liver-first resections were associated with more incomplete macroscopic disease clearances (OR 2.80, 95%CI 1.16 to 6.73) and less microscopically radical (R0) resections (OR 0.64, 95%CI 0.45 to 0.90). There were no significant differences in morbidity, mortality, disease-free or overall survival.

Conclusion: Based on meta-analysis of mainly observational studies, simultaneous resections were associated with less blood loss, shorter length of stay and more complete macroscopic disease clearances.

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同步结直肠肝转移患者围手术期安全性和肿瘤疗效：系统综述和网络荟萃分析。

背景：以往的荟萃分析就同步结直肠肝转移（sCRLM）患者的最佳手术治疗策略得出了相互矛盾的结果。本网络荟萃分析旨在概述结直肠、肝脏先切除和同时切除治疗 sCRLM 的情况：方法：在 MEDLINE、Embase 和 Cochrane CENTRAL 中进行检索（起始日期-2023 年 7 月 11 日）。以结直肠先行切除术为参照组，进行配对分析和网络荟萃分析，比较三种策略：共纳入了 46 项研究，共计 20991 名患者，其中很大一部分存在较高的偏倚风险。同步切除术的失血量较少（MD -145.44 ml，95%CI -239.40～-51.48），住院时间较短（MD -6.39天，95%CI -7.78～-4.99）。肝脏先切除与输血量增加（OR 1.89，95%CI 1.04 至 3.42）和住院时间缩短（MD -4.53天，95%CI -7.99至-1.06）有关。同时切除与不完全大体病变清除率较低（OR 0.33，95%CI 0.12 至 0.92）有关，而肝脏先切除与不完全大体病变清除率较高（OR 2.80，95%CI 1.16 至 6.73）和显微根治术（R0）切除率较低（OR 0.64，95%CI 0.45 至 0.90）有关。在发病率、死亡率、无病生存率或总生存率方面没有明显差异：结论：基于主要观察性研究的荟萃分析，同步切除术与失血量更少、住院时间更短和更完全的宏观疾病清除率相关。

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

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).