Simultaneous versus staged major hepatectomy (≥3 liver segments) for outcomes of synchronous colorectal liver metastases: A systematic review and meta‐analysis

Liu, Jianwei; Xia, Yong; Pan, Xiaorong; Yan, Zhenlin; Zhang, Lei; Zhao, Yang; Wu, Yeye; Xue, Hui; Bai, Shilei; Shen, Feng; Wang, Kui

doi:10.1002/cnr2.1617

Cited by 4 publications

(3 citation statements)

References 47 publications

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“…Major hepatectomy and minor hepatectomy were classified according to the extent of hepatectomy. Hepatectomy ≥3 liver segments is defined as major hepatectomy, 18 , 19 and hepatectomy <3 liver segments is defined as minor hepatectomy.…”

Section: Methodsmentioning

confidence: 99%

The Comparison of Surgical Margins and Type of Hepatic Resection for Hepatocellular Carcinoma With Microvascular Invasion

et al. 2023

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Objective The objective of this study was to investigate the impact of surgical margin and hepatic resection on prognosis and compare their importance on prognosis in patients with hepatocellular carcinoma (HCC). Methods The clinical data of 906 patients with HCC who underwent hepatic resection in our hospital from January 2013 to January 2015 were collected retrospectively. All patients were divided into anatomical resection (AR) (n = 234) and nonanatomical resection (NAR) group (n = 672) according to type of hepatic resection. The effects of AR and NAR and wide and narrow margins on overall survival (OS) and time to recurrence (TTR) were analyzed. Results In all patients, narrow margin (1.560, 1.278-1.904; 1.387, 1.174-1.639) is an independent risk factor for OS and TTR, and NAR is not. Subgroup analysis showed that narrow margins (2.307, 1.699-3.132; 1.884, 1.439-2.468), and NAR (1.481, 1.047-2.095; 1.372, 1.012-1.860) are independent risk factors for OS and TTR in patients with microvascular invasion (MVI)-positive. Further analysis showed that for patients with MVI-positive HCC, NAR with wide margins was a protective factor for OS and TTR compared to AR with narrow margins (0.618, 0.396-0.965; 0.662, 0.448-0.978). The 1, 3, and 5 years OS and TTR rate of the two group were 81%, 49%, 29% versus 89%, 64%, 49% (P = .008) and 42%, 79%, 89% versus 32%, 58%, 74% (P = .024), respectively. Conclusions For patients with MVI-positive HCC, AR and wide margins were protective factors for prognosis. However, wide margins are more important than AR on prognosis. In the clinical setting, if the wide margins and AR cannot be ensured at the same time, the wide margins should be ensured first.

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Section: Methodsmentioning

confidence: 99%

The Comparison of Surgical Margins and Type of Hepatic Resection for Hepatocellular Carcinoma With Microvascular Invasion

et al. 2023

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“…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 ].…”

Section: Perioperative Considerationsmentioning

confidence: 99%

Contemporary Surgical Management of Colorectal Liver Metastases

Chandra,

Sacks

2024

Cancers

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Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20–30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.

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“…Twelve meta-analyses compared the simultaneous resection of colorectal cancer and SCRLM with a traditional staged resection approach, where the primary colonic tumor is resected first [4,12,13,[15][16][17][18][19]21,23,25,26]. Survival outcomes were reported either in terms of OS or 5-year OS.…”

Section: Simultaneous Resection Vs Classic Staged ("Bowel-first") Res...mentioning

confidence: 99%

Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review

Milazzo,

Todeschini,

Caimano

et al. 2024

Cancers

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Surgical resection is the gold standard for treating synchronous colorectal liver metastases (CRLM). The resection of the primary tumor and metastatic lesions can follow different sequences: “simultaneous”, “bowel-first”, and “liver-first”. Conservative approaches, such as parenchymal-sparing surgery and segmentectomy, may serve as alternatives to major hepatectomy. A comprehensive search of Medline, Epistemonikos, Scopus, and the Cochrane Library was conducted. Studies evaluating patients who underwent surgery for CRLM and reported survival results were included. Other secondary outcomes were analyzed, including disease-free survival, perioperative complications and mortality, and recurrence rates. Quality assessment was performed using the AMSTAR-2 method. No significant differences in overall survival, disease-free survival, and secondary outcomes were observed when comparing simultaneous to “bowel-first” resections, despite a higher rate of perioperative mortality in the former group. The 5-year OS was significantly higher for simultaneous resection compared to “liver-first” resection. No significant differences in OS and DFS were noted when comparing “liver-first” to “bowel-first” resection, or anatomic to non-anatomic resection. Our umbrella review validates simultaneous surgery as an effective oncological approach for treating SCRLM, though the increased risk of perioperative morbidity highlights the importance of selecting suitable patients. Non-anatomic resections might be favored to preserve liver function and enable future surgical interventions.

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Simultaneous versus staged major hepatectomy (≥3 liver segments) for outcomes of synchronous colorectal liver metastases: A systematic review and meta‐analysis

Cited by 4 publications

References 47 publications

The Comparison of Surgical Margins and Type of Hepatic Resection for Hepatocellular Carcinoma With Microvascular Invasion

The Comparison of Surgical Margins and Type of Hepatic Resection for Hepatocellular Carcinoma With Microvascular Invasion

Contemporary Surgical Management of Colorectal Liver Metastases

Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review

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