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Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies

Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies
Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies
No consensus on the indications for surgical resection of colorectal liver metastases exists. This systematic review has been undertaken to assess the published evidence for its efficacy and safety and to identify prognostic factors. Studies were identified by computerised and hand searches of the literature, scanning references and contacting investigators. The outcome measures were overall survival, disease-free survival, postoperative morbidity and mortality, quality of life and cost effectiveness, and a qualitative summary of the trends across all studies was produced. Only 30 of 529 independent studies met all the eligibility criteria for the review, and data on 30-day mortality and morbidity only were included from a further nine studies. The best available evidence came from prospective case series, but only two studies reported outcomes for all patients undergoing surgery. The remainder reported outcomes for selected groups of patients: those undergoing hepatic resection or those undergoing curative resection. Postoperative mortality rates were generally low (median 2.8%). The majority of studies described only serious postoperative morbidity, the most common being bile leak and associated perihepatic abscess. Approximately 30% of patients remained alive 5 years after resection and around two-thirds of these are disease free. The quality of the majority of published papers was poor and ascertaining the benefits of surgical resection of colorectal hepatic metastases is difficult in the absence of randomised trials. However, it is clear that there is group of patients with liver metastases who may become long-term disease-free survivors following hepatic resection. Such survival is rare in apparently comparable patients who do not have surgical treatment. Further work is needed to more accurately define this group of patients and to determine whether the addition of adjuvant treatments results in improved survival. British Journal of Cancer (2006)
colorectal liver metastases, surgery, systematic review, survival, morbidity
0007-0920
982-999
Simmonds, P.C.
27d4c068-e352-4cbf-9899-771893788ade
Primrose, J.N.
d85f3b28-24c6-475f-955b-ec457a3f9185
Colquitt, J.L.
741c69a3-d9e0-4f10-b457-e496541e7915
Garden, O.J.
18446c7e-7d4e-466c-a762-ad594280f280
Poston, G.J.
049ddd3b-a053-40ad-af67-971542a07ec8
Rees, M.
7a007633-b3fa-4f43-981c-b851de36aea9
Simmonds, P.C.
27d4c068-e352-4cbf-9899-771893788ade
Primrose, J.N.
d85f3b28-24c6-475f-955b-ec457a3f9185
Colquitt, J.L.
741c69a3-d9e0-4f10-b457-e496541e7915
Garden, O.J.
18446c7e-7d4e-466c-a762-ad594280f280
Poston, G.J.
049ddd3b-a053-40ad-af67-971542a07ec8
Rees, M.
7a007633-b3fa-4f43-981c-b851de36aea9

Simmonds, P.C., Primrose, J.N., Colquitt, J.L., Garden, O.J., Poston, G.J. and Rees, M. (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. British Journal of Cancer, 94 (7), 982-999. (doi:10.1038/sj.bjc.6603033).

Record type: Article

Abstract

No consensus on the indications for surgical resection of colorectal liver metastases exists. This systematic review has been undertaken to assess the published evidence for its efficacy and safety and to identify prognostic factors. Studies were identified by computerised and hand searches of the literature, scanning references and contacting investigators. The outcome measures were overall survival, disease-free survival, postoperative morbidity and mortality, quality of life and cost effectiveness, and a qualitative summary of the trends across all studies was produced. Only 30 of 529 independent studies met all the eligibility criteria for the review, and data on 30-day mortality and morbidity only were included from a further nine studies. The best available evidence came from prospective case series, but only two studies reported outcomes for all patients undergoing surgery. The remainder reported outcomes for selected groups of patients: those undergoing hepatic resection or those undergoing curative resection. Postoperative mortality rates were generally low (median 2.8%). The majority of studies described only serious postoperative morbidity, the most common being bile leak and associated perihepatic abscess. Approximately 30% of patients remained alive 5 years after resection and around two-thirds of these are disease free. The quality of the majority of published papers was poor and ascertaining the benefits of surgical resection of colorectal hepatic metastases is difficult in the absence of randomised trials. However, it is clear that there is group of patients with liver metastases who may become long-term disease-free survivors following hepatic resection. Such survival is rare in apparently comparable patients who do not have surgical treatment. Further work is needed to more accurately define this group of patients and to determine whether the addition of adjuvant treatments results in improved survival. British Journal of Cancer (2006)

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More information

Published date: 14 March 2006
Keywords: colorectal liver metastases, surgery, systematic review, survival, morbidity

Identifiers

Local EPrints ID: 62927
URI: http://eprints.soton.ac.uk/id/eprint/62927
ISSN: 0007-0920
PURE UUID: 0688fc3f-f153-4f2b-9752-f6754f232bb4
ORCID for J.N. Primrose: ORCID iD orcid.org/0000-0002-2069-7605

Catalogue record

Date deposited: 04 Sep 2008
Last modified: 03 Dec 2019 02:02

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