Drs Hillings and Wille-Jørgensen from Denmark undertook a systematic review of the literature comparing staged and simultaneous resection of synchronous liver metastases from colorectal cancer.
The team estimated the differences in length of hospital stay, morbidity, mortality and long-term survival, and determined the level of evidence for recommendations of a treatment strategy.
The team preformed a Pub-med search for studies comparing patients with synchronous liver metastases, who either had a combined or staged resection of metastases.
The research team considered 26 trials but included 16 based on the Newcastle Ottawa Quality Assessment Scale.
All studies were retrospective and had a general bias, because the staged procedure was undertaken more often in patients with left-sided primary tumors and larger, more numerous and bi-lobar metastases.
Analyses of primary outcomes were performed using the random effects model.
|11 studies compared 5-year survival|
In 11 studies, there was a tendency towards a shorter hospital stay in the synchronous resection group.
The researchers found 14 studies that compared total perioperative morbidity.
The team observed lower morbidity in favor of a combined resection.
The team identified 15 studies that compared perioperative mortality, which seemed to be lower with the staged approach.
The research team found 11 studies comparing 5-year survival, which seemed to be similar in the 2 groups.
Dr Hillings and colleague concluded, “No randomized controlled trials were identified, and hence a meta-analysis was not performed.”
“The evidence level is 2 to 3 with grade C recommendations.”
“Synchronous resections can be undertaken in selected patients, provided that surgeons specialized in colorectal and hepatobiliary surgery are available.”