• Please log in or register to access this feature.

Clinical Observations in Hepatology

Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): Simultaneous or delayed?†

  1. Zi Yin MD1,2,
  2. Chao Liu MD, PhD1,
  3. Yajin Chen MD, PhD1,
  4. Yu Bai MD4,
  5. hangzhen Shang MD, PhD1,
  6. Rongyan Yin MD5,
  7. Dong Yin PhD2,3,*,
  8. Jie Jie Wang MD, PhD1,*

DOI: 10.1002/hep.26283

Additional Information

Author Information

  1. 1

    General Surgery Department of Sun Yat-sen Memorial Hospital,Sun Yat-sen University, Guangzhou, China

  2. 2

    Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institute, Sun Yat-sen University, Guangzhou, China

  3. 3

    Division of Hematology and Oncology, Cedars-Sinai Medical Center, University of California at Los Angeles School ofMedicine, Los Angeles, CA

  4. 4

    Department of Gastroenterology of Affiliated Changhai hospital, Second military medical university, Shanghai, China

  5. 5

    Centers for Disease Control and Prevention of Guizhou Province, Guiyang, China

*General Surgery Department of Sun Yat-sen Memorial Hospital, #Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institute, Sun Yat-sen University, Guangzhou, China

  1. †

    Conflict of Interest: All authors declare no conflict of interest

Publication History

  1. Accepted manuscript online: 28 JAN 2013 03:56PM EST
  2. Manuscript Revised: 20 NOV 2012
  3. Manuscript Received: 24 SEP 2012
  4. Manuscript Accepted: 6 JAN 2012

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

Get PDF (3290K)

Keywords:

  • SCRLM;
  • Simultaneous resection;
  • Delayed resection;
  • Systematic review;
  • Meta-analysis

Abstract

The optimal surgical strategy for treatment of patients with synchronous colorectal liver metastases (SCLRM) remains controversial.We conducted a systematic review and meta-analysis of all observational studies to define the safety and efficacy of simultaneous versus delayed resection of the colon and liver. A search for all major databases and relevant journals from inception to April 2012 without restriction on languages or regions was performed. Outcome measures were primary parameters of postoperative survival, complicationand mortality, as well as other parameters of blood loss, operative time and length of hospitalization. The test of heterogeneity was performed with the Q statistic. A totalof 2880 patients were included in the meta-analysis. Long-term oncological pooled estimatesof overall survival (HR: 0.96; 95%CI: 0.81-1.14; P = 0.64; I2 = 0) and recurrence-free survival (HR: 1.04; 95%CI: 0.76-1.43; P = 0.79; I2 = 53%) all showed similar outcomes for both simultaneous and delayed resections.A lower incidence of postoperative complicationwas implied in simultaneous group than that in delayed group (modified RR= 0.77; 95%CI: 0.67- 0.89; P = 0.0002; I2 = 10%), whereas in terms of mortality within postoperative sixty days no statistical difference was detected (RR = 1.12; 95%CI: 0.61-2.08; P = 0.71; I2 = 32%).Finally, selection criteria were recommended for SCRLM patients suitable for a simultaneous resection.

Conclusions:

Simultaneous resection is as efficient as delayed procedure for the long-term survival. There are evidences implied that in SCRLM patients simultaneous resection is an acceptable and safe option with the carefully good selected conditions.Due to inherent limitations of the present study, future randomized controlled trials are eagerly awaited to confirm this conclusion. (HEPATOLOGY 2013.)

Get PDF (3290K)