Meta-analysis of clinical outcome after first and second liver resection for colorectal metastases


Antoniou, Anthony, Lovegrove, Richard E., Tilney, Henry S., Heriot, Alexander G., John, Timothy G., Rees, Myrddin, Tekkis, Paris P. and Welch, Fenella K.S. (2007) Meta-analysis of clinical outcome after first and second liver resection for colorectal metastases. Surgery, 141, (1), 9-18. (doi:10.1016/j.surg.2006.07.045).

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Description/Abstract

Background

The perioperative risk and long-term survival benefit of repeat hepatectomy for patients with liver metastases from colorectal cancer, compared with that of a first liver resection, has been reported with varying results in the literature.

Methods

The literature was searched using Medline, Embase, Ovid, and Cochrane databases for all studies published from 1992 to 2006. Two authors independently extracted data using the following outcomes: postoperative complications and mortality; disease recurrence; and long-term survival. Trials were assessed using the modified Newcastle-Ottawa Score. Random-effect meta-analytical techniques were used for analysis.

Results

Twenty-one studies met the inclusion criteria, comprising 3,741 patients. The use of adjuvant chemotherapy was similar in both groups (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.54, 1.74; P = .92), as was the number of hepatic nodules present at the time of first or second resection (weighted mean difference [WMD] = 0.18; 95% CI = −0.22, 0.57; P = .380). Wedge resection was carried out less often at first hepatectomy (39% vs 46%; OR = 0.66; 95% CI = 0.44, 1.00; P = .05). There was significantly less blood loss in patients undergoing first versus second hepatectomy (WMD = 238 ml; 95% CI = 90, 385; P = .002). There was no difference in perioperative morbidity (OR = 1.01; 95% CI = 0.65, 1.55; P = .98), mortality (OR = 1.01; 95% CI = 0.18, 5.72; P = .99) or long-term survival (HR = 0.90; 95% CI = .66, 1.24; P = .530) between groups.

Conclusions

Repeat hepatectomy for patients with colorectal cancer metastases is safe and provides survival benefit equal to that of a first liver resection.

Item Type: Article
ISSNs: 0039-6060 (print)
Related URLs:
Keywords: outcomes, survival, mortality, recurrent metastases, central venous-pressure, repeat hepatic resection, natural-history, elderly-patients, colorectal-cancer, liver resection, liver, carcinoma, colorectal metastases, disease, radiofrequency ablation,cancer, hepatectomy
Subjects: R Medicine > RD Surgery
R Medicine
Divisions: University Structure - Pre August 2011 > School of Medicine > Developmental Origins of Health and Disease
University Structure - Pre August 2011 > School of Medicine > Cancer Sciences
University Structure - Pre August 2011 > School of Medicine
ePrint ID: 62672
Date Deposited: 11 Sep 2008
Last Modified: 27 Mar 2014 18:44
URI: http://eprints.soton.ac.uk/id/eprint/62672

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