Humam Shah, Naveed Ahmed Khan, Muhammad Imran Ullah, Umer Zaryab Khan, Uzair Irfan, Iftikhar Ahmad
{"title":"热消融与手术切除治疗结直肠癌肝转移的疗效比较：系统综述和meta分析。","authors":"Humam Shah, Naveed Ahmed Khan, Muhammad Imran Ullah, Umer Zaryab Khan, Uzair Irfan, Iftikhar Ahmad","doi":"10.1007/s12029-025-01314-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Colorectal cancer (CRC) often involves liver. However, the standard treatment for CRC with liver metastases (CRC-LM) is debatable. This meta-analysis compares the efficacy of ablation with surgical resection in CRC-LM patients.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, ClinicalTrials.gov and Cochrane Library. Studies published during January 2020 to February 2025 and comparing any form of ablation with surgical resection in adult patients with CRC-LM were included. The primary outcomes were overall survival (OS), disease-free survival (DFS), while the secondary outcomes were recurrence patterns, length of hospital stay, and complication rates.</p><p><strong>Results: </strong>A total of 15 studies were included in the meta-analysis. The pooled analysis revealed a significant difference in OS favoring surgical resection (RR: 0.82, 95% CI: 0.73, 0.92, p = 0.001, I<sup>2</sup> = 33%), while DFS showed no significant difference between the groups (RR: 0.76, 95% CI: 0.38, 1.53, p = 0.44, I<sup>2</sup> = 85%). Hospital stay was significantly shorter in the ablation group (MD -1.44; 95% CI -2.18,-0.69; p = 0.0001; I<sup>2</sup> = 97%), and the rate of major complications was also significantly lower with ablation (RR 0.26; 95% CI 0.18-0.38; p < 0.00001; I<sup>2</sup> = 0%). Additionally, ablation and resection were comparable in terms of both local recurrence (RR 1.27; 95% CI 0.86-1.86; p = 0.23; I<sup>2</sup> = 38%) and appearance of new lesions (RR 0.98; 95% CI 0.75-1.29; p = 0.90; I<sup>2</sup> = 9%).</p><p><strong>Conclusion: </strong>Surgical resection offered superior OS compared to thermal ablation for CRC-LM patients. However, thermal ablation was associated with shorter hospital stay and fewer major complications, highlighting its value as a less invasive alternative in selected patients.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"188"},"PeriodicalIF":1.6000,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative Efficacy of Thermal Ablation and Surgical Resection in Patients with Colorectal Cancer Liver Metastasis: A Systematic Review and Meta-analysis.\",\"authors\":\"Humam Shah, Naveed Ahmed Khan, Muhammad Imran Ullah, Umer Zaryab Khan, Uzair Irfan, Iftikhar Ahmad\",\"doi\":\"10.1007/s12029-025-01314-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Colorectal cancer (CRC) often involves liver. However, the standard treatment for CRC with liver metastases (CRC-LM) is debatable. This meta-analysis compares the efficacy of ablation with surgical resection in CRC-LM patients.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, ClinicalTrials.gov and Cochrane Library. Studies published during January 2020 to February 2025 and comparing any form of ablation with surgical resection in adult patients with CRC-LM were included. The primary outcomes were overall survival (OS), disease-free survival (DFS), while the secondary outcomes were recurrence patterns, length of hospital stay, and complication rates.</p><p><strong>Results: </strong>A total of 15 studies were included in the meta-analysis. The pooled analysis revealed a significant difference in OS favoring surgical resection (RR: 0.82, 95% CI: 0.73, 0.92, p = 0.001, I<sup>2</sup> = 33%), while DFS showed no significant difference between the groups (RR: 0.76, 95% CI: 0.38, 1.53, p = 0.44, I<sup>2</sup> = 85%). Hospital stay was significantly shorter in the ablation group (MD -1.44; 95% CI -2.18,-0.69; p = 0.0001; I<sup>2</sup> = 97%), and the rate of major complications was also significantly lower with ablation (RR 0.26; 95% CI 0.18-0.38; p < 0.00001; I<sup>2</sup> = 0%). Additionally, ablation and resection were comparable in terms of both local recurrence (RR 1.27; 95% CI 0.86-1.86; p = 0.23; I<sup>2</sup> = 38%) and appearance of new lesions (RR 0.98; 95% CI 0.75-1.29; p = 0.90; I<sup>2</sup> = 9%).</p><p><strong>Conclusion: </strong>Surgical resection offered superior OS compared to thermal ablation for CRC-LM patients. However, thermal ablation was associated with shorter hospital stay and fewer major complications, highlighting its value as a less invasive alternative in selected patients.</p>\",\"PeriodicalId\":15895,\"journal\":{\"name\":\"Journal of Gastrointestinal Cancer\",\"volume\":\"56 1\",\"pages\":\"188\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-09-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Gastrointestinal Cancer\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12029-025-01314-9\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastrointestinal Cancer","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12029-025-01314-9","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：结直肠癌（CRC）常累及肝脏。然而，CRC合并肝转移（CRC- lm）的标准治疗是有争议的。本荟萃分析比较了CRC-LM患者消融与手术切除的疗效。方法：系统检索PubMed、ClinicalTrials.gov和Cochrane Library的文献。纳入了2020年1月至2025年2月期间发表的研究，比较了成年CRC-LM患者的任何形式的消融与手术切除。主要结局是总生存期（OS）、无病生存期（DFS），次要结局是复发模式、住院时间和并发症发生率。结果：meta分析共纳入15项研究。合并分析显示，赞成手术切除的OS有显著差异（RR: 0.82, 95% CI: 0.73, 0.92, p = 0.001, I2 = 33%），而DFS组间无显著差异（RR: 0.76, 95% CI: 0.38, 1.53, p = 0.44, I2 = 85%）。消融术组住院时间明显缩短（MD -1.44; 95% CI -2.18,-0.69; p = 0.0001; I2 = 97%），主要并发症发生率也明显降低（RR 0.26; 95% CI 0.18-0.38; p 2 = 0%）。此外，消融和切除在局部复发率（RR 1.27; 95% CI 0.86-1.86; p = 0.23; I2 = 38%）和新病灶的出现（RR 0.98; 95% CI 0.75-1.29; p = 0.90; I2 = 9%）方面具有可比性。结论：与热消融相比，手术切除为CRC-LM患者提供了更好的OS。然而，热消融与更短的住院时间和更少的主要并发症相关，突出了其作为一种侵入性较小的替代方法在选定患者中的价值。
Comparative Efficacy of Thermal Ablation and Surgical Resection in Patients with Colorectal Cancer Liver Metastasis: A Systematic Review and Meta-analysis.
Purpose: Colorectal cancer (CRC) often involves liver. However, the standard treatment for CRC with liver metastases (CRC-LM) is debatable. This meta-analysis compares the efficacy of ablation with surgical resection in CRC-LM patients.
Methods: A systematic literature search was conducted in PubMed, ClinicalTrials.gov and Cochrane Library. Studies published during January 2020 to February 2025 and comparing any form of ablation with surgical resection in adult patients with CRC-LM were included. The primary outcomes were overall survival (OS), disease-free survival (DFS), while the secondary outcomes were recurrence patterns, length of hospital stay, and complication rates.
Results: A total of 15 studies were included in the meta-analysis. The pooled analysis revealed a significant difference in OS favoring surgical resection (RR: 0.82, 95% CI: 0.73, 0.92, p = 0.001, I2 = 33%), while DFS showed no significant difference between the groups (RR: 0.76, 95% CI: 0.38, 1.53, p = 0.44, I2 = 85%). Hospital stay was significantly shorter in the ablation group (MD -1.44; 95% CI -2.18,-0.69; p = 0.0001; I2 = 97%), and the rate of major complications was also significantly lower with ablation (RR 0.26; 95% CI 0.18-0.38; p < 0.00001; I2 = 0%). Additionally, ablation and resection were comparable in terms of both local recurrence (RR 1.27; 95% CI 0.86-1.86; p = 0.23; I2 = 38%) and appearance of new lesions (RR 0.98; 95% CI 0.75-1.29; p = 0.90; I2 = 9%).
Conclusion: Surgical resection offered superior OS compared to thermal ablation for CRC-LM patients. However, thermal ablation was associated with shorter hospital stay and fewer major complications, highlighting its value as a less invasive alternative in selected patients.
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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