Abstract
Background: Patients presenting with synchronous colorectal liver metastases are increasingly
being considered for a curative treatment, and the liver-first approach is gaining popularity in this
context. However, little is known about the completion rates of the liver-first approach and its
effects on survival.
Methods:A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis.
The primary outcome was an assessment of the completion rates of the liver-first approach.
Secondary outcomes included overall survival, causes of non-completion, and clinicopathologic
data.
Results: Seventeen articles were amenable for inclusion and the total study population was 1041.
The median completion rate for the total population was 80% (range 20–100). The median overall
survival for the completion and non-completion groups was 45 (range 12–69) months and 13 (range
10.5–25) months, respectively. Metadata showed a significant survival benefit for the completion
group, with a univariate hazard ratio of 12.0 (95% confidence interval, range 5.7–24.4). The major
cause of non-completion (76%) was liver disease progression before resection of the primary
tumor. Pearson tests showed significant negative correlation between median number of lesions
and median size of the largest metastasis and completion rate.
Conclusions: The liver-first approach offers a complete resection to most patients enrolled, with
an overall survival benefit when completion can be assured. One-fifth fails to return to intended
oncologic therapy and the major cause is interim metastatic progression, most often in the liver.
Risk of non-completion is related to a higher number of lesions and large metastases. The majority
of studies stem from primary
being considered for a curative treatment, and the liver-first approach is gaining popularity in this
context. However, little is known about the completion rates of the liver-first approach and its
effects on survival.
Methods:A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis.
The primary outcome was an assessment of the completion rates of the liver-first approach.
Secondary outcomes included overall survival, causes of non-completion, and clinicopathologic
data.
Results: Seventeen articles were amenable for inclusion and the total study population was 1041.
The median completion rate for the total population was 80% (range 20–100). The median overall
survival for the completion and non-completion groups was 45 (range 12–69) months and 13 (range
10.5–25) months, respectively. Metadata showed a significant survival benefit for the completion
group, with a univariate hazard ratio of 12.0 (95% confidence interval, range 5.7–24.4). The major
cause of non-completion (76%) was liver disease progression before resection of the primary
tumor. Pearson tests showed significant negative correlation between median number of lesions
and median size of the largest metastasis and completion rate.
Conclusions: The liver-first approach offers a complete resection to most patients enrolled, with
an overall survival benefit when completion can be assured. One-fifth fails to return to intended
oncologic therapy and the major cause is interim metastatic progression, most often in the liver.
Risk of non-completion is related to a higher number of lesions and large metastases. The majority
of studies stem from primary
| Original language | English |
|---|---|
| Article number | 14574969211030131 |
| Journal | Scandinavian Journal of Surgery |
| DOIs | |
| Publication status | Published - 2021 Oct 3 |
Subject classification (UKÄ)
- Surgery