Safety and long-term prognosis of simultaneous versus staged resection in synchronous colorectal cancer with liver metastasis: a systematic review and meta-analysis

Abstract

Purpose The optimal time point for surgical resection of synchronous colorectal liver metastases (SCLMs) is still controversial. This meta-analysis evaluated the safety and long-term prognoses of simultaneous and staged resection of SCLM to provide a reference for clinical selection. Methods A systematic literature search for studies published by October 2022 was performed using PubMed, Web of Science, Embase, Scopus and Cochrane Library. The evaluated outcome parameters were total, gastrointestinal and hepatic complications, as well as perioperative mortality, intraoperative blood loss, total hospital stay, 5-year disease-free survival (DFS) and 5-year overall survival (OS). Results This meta-analysis included 22 nonrandomised and one randomised study comprising 4862 patients. The patients undergoing simultaneous resection of SCLM had similar total (OR = 0.88, 95% CI [0.66–1.19], P = 0.409), gastrointestinal (OR = 1.19, 95% CI [0.89–1.59], P = 0.241) and hepatic (OR = 1.04, 95% CI [0.83–1.31], P = 0.734) complications, as well as perioperative mortality (OR = 1.79, 95% CI [0.88–3.64], P = 0.108), 5-year DFS (HR = 1.26, 95% CI [0.96–1.66], P = 0.098) and 5-year OS (HR = 1.13, 95% CI [0.95–1.34], P = 0.164). Lower intraoperative blood loss (SMD = − 0.39, 95% CI [− 0.60 to − 0.18], P < 0.001) and shorter total hospital stay (WMD = − 5.43, 95% CI [− 7.29 to − 3.58], P < 0.001) were observed in the simultaneous-resection group versus the staged group. Conclusions Simultaneous resection is safe and effective for SCLM patients. The long-term prognosis is equivalent to that of the traditional staged resection. Correct selection of resectable SCLM patients for the simultaneous resection of the primary tumour and liver metastases can be the first choice. Owing to the potential heterogeneity, more RCTs should be included to verify our conclusions.

Propensity-score matched outcomes of resection of stage IV primary colon cancer with and without simultaneous resection of liver metastases

“…The significant predictors of complications were medical comorbidities and major hepatectomy, which increased the complication rate to 40%. A recent meta-analysis [ 9 ] concluded that simultaneous resection of the primary tumor and liver metastases can be the first choice in patients with resectable synchronous CLM.…”

“…Treatment of synchronous liver metastases, concurrent with, before, or after resection of the primary colon cancer, may improve OS. A meta-analysis showed that simultaneous resection of CLM confers equivalent long-term prognosis to that of staged resection and is overall safe with similar odds of total and organ-specific complications and perioperative mortality [ 9 ].…”

Contemporary Surgical Management of Colorectal Liver Metastases

“…For synchronous CRLM, the SR approach has been studied extensively. The proposed benefits of this approach include avoiding the morbidity and complications associated with performing a second operation, such as the inherent risks of anesthesia, need for a second hospital stay, potential for increased healthcare costs, and periprocedural pain, for example [ 64 ]. Additionally, this approach has the added benefit of addressing the liver disease immediately, thereby avoiding issues where disease progression can subsequently exclude hepatectomy.…”

“…In conclusion, there is merit to each surgical approach, and the decision to pursue one over the other requires an individualized approach to each patient, bearing in mind that there has been no difference in survival shown between them [ 64 , 69 , 72 ].…”

Nomogram predicting early recurrence defined by the minimum P value approach for colorectal liver metastasis patients receiving colorectal cancer resection with simultaneous liver metastasis resection: development and validation

“…Colorectal cancer (CRC) has become a predominant cancer and ranks as the second most common cause of death due to cancer worldwide ( 1 ). Liver metastases represent the major cause of CRC-related mortality ( 2 ), and synchronous liver metastases occur in up to 25% ( 3 ) of CRC patients at diagnosis.…”