Resection versus no intervention or other surgical interventions for colorectal cancer liver metastases

 

Abstract

Background

Up to 50% of patients with colorectal cancer develop metastases of which half are isolated to the liver and 10% to 25% are eligible for resection. If all disease is removed these patients have a 30% to 50% chance of survival at five years.
Treatment options include hepatic resection and other modalities using cryosurgery and radiofrequency thermal ablation. Although these new modalities allow safe ablation of liver metastases often without the need for surgical intervention, there are still no clear guidelines on the appropriate management of patients with colorectal cancer liver metastases.

Objectives

To assess the effects of surgical resection of colorectal cancer liver metastases compared to no intervention and other modalities of intervention, including cryosurgery and radiofrequency ablation.

Search methods

Searches were conducted in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS databases and updated 14 June 2011.

Selection criteria

Randomized controlled trials comparing resection or other surgical interventions for liver metastases in participants who had undergone curative surgery for adenocarcinoma of the colon or rectum and who were eligible for liver resection (i.e. with no evidence of primary or metastatic cancer elsewhere).

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data.

Main results

Only one trial with a high risk of bias involving 123 people (87 male 36 female) was included in this review. The data from this ten year randomized controlled trial suggest that cryosurgery may be effective in the treatment of liver metastases. The investigators reported higher disease free survival rates at 10 years in those patients who received the cryosurgery compared to conventional surgical techniques.

Authors' conclusions

The single study included in this review provides very limited evidence to support the effectiveness of one intervention over the other. The authors conclude that local ablative therapies might be useful for the management of liver metastases, but more research is required to further evaluate the effects of these treatment options and their potential role in increasing disease-free survival and in decreasing recurrence rates.

 

Plain language summary

Resection versus no intervention or other surgical interventions for colorectal cancer liver metastases

Almost half of patients with colorectal cancer develop metastases many of which are located in the liver, and a quarter of which may be amendable to surgery. If all disease is removed these patients have a 30% to 50% chance of survival at five years.
Treatment options include surgical removal of the diseased section of the liver as well as other modalities such as cryosurgery and radiofrequency thermal ablation. Although new treatments allow safe destruction of liver metastases, often without the need for major surgery, there are still no clear guidelines on the appropriate management of patients with colorectal cancer liver metastases. Only one low quality study which reported improved disease-free survival in patients who underwent cryosurgery compared with conventional techniques, was included in this review.

There is very limited evidence to support the effectiveness or otherwise of a single approach, either surgical resection or other surgical procedure for the management of colorectal liver metastases. Further research is required to evaluate the effects of these treatment options and their role in increasing disease-free survival and in decreasing recurrence. Treatment decisions should continue to be based on individual circumstances and clinician's experience.

 

摘要

背景

比較進行切除手術和非介入性治療或其他手術性介入治療對於大腸直腸癌肝臟轉移的影響

每4個患有轉移性大腸直腸癌的患者中便有1個患者的癌細胞會轉移至肝臟，在這之中，有10至25％的患者可以切除轉移至肝臟的癌細胞，並且提升5年存活率，一般的治療方法包括肝臟切除(hepatic resection)和利用冷凍手術或射頻加熱壞死消融療法(radiofrequency thermal ablation)這類的非手術性癌細胞消融法進行治療，雖然新的療法可以在不進行手術性介入治療下安全的將轉移至肝臟的癌細胞移除，但是目前仍缺乏明確的指標來處置大腸直腸癌和肝臟轉移患者

目標

本研究的主要目的在於比較將轉移至肝臟的癌細胞進行切除和不使用介入性治療或其他種類介入性治療(包括冷凍手術和射頻消融法)進行治療的益處和危害

搜尋策略

我們由MEDLINE、Embase和Cochrane Controlled Trials Register等資料庫確認相關的隨機性對照試驗(檢索時間至2006年10月)，檢索策略是由MEDLINE資料庫所發展出來的並進行適度的調整以因應每個資料庫的規定，此外，在確認適當納入研究的試驗過程中，也會瀏覽相關的參考文獻清單

選擇標準

我們只考慮針對以任何年紀、任何性別進行大腸或直腸癌治癒手術、被診斷具有肝臟移轉現象並且考慮進行肝臟切除(也就是說在其他部位沒有出現主要或轉移性癌細胞)的患者受試對象的隨機性對照試驗

資料收集與分析

有2個審閱者，獨立的利用本研究特別設計的資料萃取格式來進行資料萃取和評估試驗品質，看法上的差異係利用共識來加以解決

主要結論

只有1個試驗完全符合本研究的納入標準，根據這個為期10年的前瞻性、隨機性臨床試驗的數據可以推測，進行肝臟冷凍手術可以有效的治療可切除性或不可切除性轉移至肝臟的癌細胞，這些結果顯示對於這些患者來說，達到手術中癌細胞的消失(大於等於90％或小於等於97％)和延長存活率的效果，這個研究指出，在進行冷凍手術後，患者5年和10年的存活率分別為44％和19％，但是要將由大腸直腸癌轉移肝臟的患者(66.6％)所取得的數據和由其他癌症轉移到肝臟的患者所取得的數據進行分離是不太可能的

作者結論

近來有一些不充分的證據顯示單一方法，不管是手術性方法或非手術性方法對於大腸直腸癌肝臟轉移是有幫助的，所以應該依據患者狀況和醫師的經驗來訂定治療策略，我們同意局部消融治療應該是有效的，但是需要更多的隨機性對照試驗來提出更多的評估

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

切除治療和非介入性治療或其他介入性手術治療對於大腸直腸癌細胞移轉至肝臟的治療效果。 每4個移轉性大腸直腸癌患者中便有1個患者的癌細胞會轉移到肝臟，其中有10％至25％的患者可以經由消融法來移除轉移到肝臟的癌細胞， 初步性的數據指出癌細胞消融治療可以針對適當挑選發生肝臟轉移的患者達到提升存活率的效果，長期存活評估認為患者接受消融治療是有好處的，而將消融治療與肝臟切除治療進行比較對於肝臟轉移治療來說是一項很重要的議題，本研究比較了手術治療和其他方法的治療效益，其中只有一個包含有123名患者的試驗被納入研究中，並沒有證據可以支持單一療法，不管是手術性方法或其他方法可以用來治療大腸直腸癌的肝臟移轉，所以應該依據患者狀況和醫師的經驗來訂定治療策略