Efficacy and safety of simultaneous resection vs staged resection in the treatment of synchronous colorectal liver metastasis: A Meta-analysis

doi:10.3877/cma.j.issn.1674-0793.2021.06.015

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of simultaneous resection compared with staged resection for synchronous colorectal liver metastases (CRLM) through the method of systematic evaluation.

Methods

A literature search was performed including PubMed, Cochrane Library, Embase, CNKI, Wanfang data and VIP databases from January 2011 to April 2021. The data were processed using RevMan 5.3 for Meta-analysis.

Results

A total of 3 937 patients were included in 18 articles, including 1 767 patients undergoing simultaneous resection and 2 170 patients undergoing staged resection. The incidence of perioperative complications in the simultaneous resection group was higher than staged operation group (OR=1.23, 95% CI: 1.05, 1.46, P=0.01), the operative time was shorter (WMD= -162.11, 95% CI: -212.49, -111.73, P<0.001), and the postoperative hospital stay was less (WMD= -8.19, 95% CI: -10.56, -5.81, P<0.001). There were no significant differences in perioperative mortality, R0 resection rate, 5-year overall survival rate or intraoperative blood loss.

Conclusion

For patients with synchronous CRLM, simultaneous resection may has a higher incidence of complications, and staged resection is still a good choice for patients with poor tolerance, late stage of the primary tumor, large range of liver resection and other conditions that may increase the difficulty of surgery.

Key words: Colorectal Neoplasms, Liver matastases, Simultaneous resection, Staged resection

Jiayang Ma, Dapeng Kang, Wenxing Li. Efficacy and safety of simultaneous resection vs staged resection in the treatment of synchronous colorectal liver metastasis: A Meta-analysis[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 466-471.

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References 31

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第一作者及年份	国家	病例来源年限	总例数	分组	例数	性别(例)		原发灶位置(例)		原发肿瘤分期(例)		NOS评分
第一作者及年份	国家	病例来源年限	总例数	分组	例数	男	女	结肠	直肠	T1/T2	T3/T4	NOS评分
Abbott, 2012^[25]	美国	1993—2010	144	S	60	40	20	26	34	8	50	9
				D	84	49	35	31	53	9	75
胡俊杰, 2013^[23]	中国	1999—2009	53	S	40	25	15	22	18	NA	NA	8
				D	13	6	7	6	7	NA	NA
Mayo, 2013^[24]	多国家	1982—2011	1 004	S	329	185	144	238	91	NA	NA	8
				D	675	413	262	488	185	NA	NA
She, 2015^[22]	中国	1990—2008	116	S	28	22	6	69	19	NA	NA	9
				D	88	59	29	15	13	NA	NA
张远通, 2016^[21]	中国	2008—2013	65	S	46	28	18	25	21	7	39	8
				D	19	9	10	9	10	3	16
Silberhumer, 2016^[20]	美国	1984—2008	429	S	320	170	150	177	143	51	269	7
				D	109	68	41	56	53	18	91
Li, 2016^[19]	中国	2009—2013	73	S	60	38	22	34	26	NA	NA	7
				D	13	10	3	6	7	NA	NA
Fukami, 2016^[18]	日本	2006—2013	63	S	41	18	23	25	16	NA	NA	7
				D	22	12	10	10	12	NA	NA
Inoue, 2017^[17]	日本	1995—2015	107	S	31	13	18	18	13	23	8	8
				D	76	43	33	41	34	53	23
Nanji, 2017^[16]	加拿大	1996—2009	226	S	100	124	102	NA	NA	40	60	8
				D	126	54	46	NA	NA	63	63
Alexandrescu, 2017^[15]	罗马尼亚	1995—2015	300	S	234	132	102	154	80	NA	NA	6
				D	66	35	31	53	13	NA	NA
Le Souder, 2018^[14]	加拿大	2005—2016	155	S	28	15	13	25	3	2	25	7
				D	127	73	54	91	36	6	121
唐良振, 2020^[13]	中国	2015—2017	76	S	45	24	21	23	22	NA	NA	8
				D	31	17	14	16	15	NA	NA
Valdimarsson, 2020^[10]	瑞典	2008—2015	537	S	160	90	70	125	35	NA	NA	8
				D	377	234	143	262	115	NA	NA
Slupski, 2020^[12]	波兰	1997—2012	131	S	52	35	17	32	20	9	43	8
				D	79	44	35	58	21	13	66
Wang, 2020^[11]	中国	2007—2016	233	S	86	45	41	62	24	NA	NA	7
				D	147	98	49	85	62	NA	NA
Nitsche, 2020^[9]	德国	2007—2016	140	S	68	38	30	40	28	NA	NA	8
				D	72	48	24	40	32	NA	NA
Boudjema, 2021^[26]	法国	2006—2015	85	S	39	25	14	27	12	NA	NA	-
				D	46	25	21	25	21	NA	NA

第一作者及年份	国家	病例来源年限	总例数	分组	例数	性别(例)		原发灶位置(例)		原发肿瘤分期(例)		NOS评分
第一作者及年份	国家	病例来源年限	总例数	分组	例数	男	女	结肠	直肠	T1/T2	T3/T4	NOS评分
Abbott, 2012^[25]	美国	1993—2010	144	S	60	40	20	26	34	8	50	9
				D	84	49	35	31	53	9	75
胡俊杰, 2013^[23]	中国	1999—2009	53	S	40	25	15	22	18	NA	NA	8
				D	13	6	7	6	7	NA	NA
Mayo, 2013^[24]	多国家	1982—2011	1 004	S	329	185	144	238	91	NA	NA	8
				D	675	413	262	488	185	NA	NA
She, 2015^[22]	中国	1990—2008	116	S	28	22	6	69	19	NA	NA	9
				D	88	59	29	15	13	NA	NA
张远通, 2016^[21]	中国	2008—2013	65	S	46	28	18	25	21	7	39	8
				D	19	9	10	9	10	3	16
Silberhumer, 2016^[20]	美国	1984—2008	429	S	320	170	150	177	143	51	269	7
				D	109	68	41	56	53	18	91
Li, 2016^[19]	中国	2009—2013	73	S	60	38	22	34	26	NA	NA	7
				D	13	10	3	6	7	NA	NA
Fukami, 2016^[18]	日本	2006—2013	63	S	41	18	23	25	16	NA	NA	7
				D	22	12	10	10	12	NA	NA
Inoue, 2017^[17]	日本	1995—2015	107	S	31	13	18	18	13	23	8	8
				D	76	43	33	41	34	53	23
Nanji, 2017^[16]	加拿大	1996—2009	226	S	100	124	102	NA	NA	40	60	8
				D	126	54	46	NA	NA	63	63
Alexandrescu, 2017^[15]	罗马尼亚	1995—2015	300	S	234	132	102	154	80	NA	NA	6
				D	66	35	31	53	13	NA	NA
Le Souder, 2018^[14]	加拿大	2005—2016	155	S	28	15	13	25	3	2	25	7
				D	127	73	54	91	36	6	121
唐良振, 2020^[13]	中国	2015—2017	76	S	45	24	21	23	22	NA	NA	8
				D	31	17	14	16	15	NA	NA
Valdimarsson, 2020^[10]	瑞典	2008—2015	537	S	160	90	70	125	35	NA	NA	8
				D	377	234	143	262	115	NA	NA
Slupski, 2020^[12]	波兰	1997—2012	131	S	52	35	17	32	20	9	43	8
				D	79	44	35	58	21	13	66
Wang, 2020^[11]	中国	2007—2016	233	S	86	45	41	62	24	NA	NA	7
				D	147	98	49	85	62	NA	NA
Nitsche, 2020^[9]	德国	2007—2016	140	S	68	38	30	40	28	NA	NA	8
				D	72	48	24	40	32	NA	NA
Boudjema, 2021^[26]	法国	2006—2015	85	S	39	25	14	27	12	NA	NA	-
				D	46	25	21	25	21	NA	NA

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