Comparative efficacy of common adjuvant treatments after resection of colorectal liver metastases: A systematic review and network meta-analysis.

Abstract

Background: Although adjuvant strategies such as systemic chemotherapy, regional nonsystemic chemotherapy, and ablation have been applied, the optimal adjuvant therapeutic strategy for resectable colorectal liver metastases remains uncertain in terms of overall survival and disease-free survival. This network meta-analysis aimed to determine the optimal adjuvant therapeutic strategy for patients with colorectal liver metastases.

Methods: We searched potentially eligible studies in PubMed, Embase, Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure databases until July 2026. Pooled disease-free survival (DFS) and overall survival (OS) were estimated using R software.

Results: Eighteen studies including 18 reports were included. For the DFS, except for adjuvant hepatic arterial infusion chemotherapy (CT, HAIC) concomitant with intravenous CT, adjuvant CT and perioperative CT significantly improved DFS compared with surgery and adjuvant HAIC. There was no statistical difference between all therapeutic strategies for OS. Adjuvant HAIC concomitant with intravenous CT had the highest probability of being the best treatment for improving DFS (85.01%), followed by perioperative CT (11.75%) and adjuvant CT (3.17%); however, adjuvant HAIC concomitant with intravenous CT had the highest probability of being the best adjuvant treatment for improving OS (52.46%), followed by perioperative CT (40.25%) and adjuvant HAIC (5.25%).

Conclusion: Adjuvant CT may be the best for improving DFS, but perioperative CT may be the best for improving OS. However, the results should be validated further.