The liver-first approach for synchronous colorectal liver metastases: A systematic review and meta-analysis of completion rates and effects on survival

• Background: Patients presenting with synchronous colorectal liver metastases are increasinglybeing considered for a curative treatment, and the liver-first approach is gaining popularity in thiscontext. However, little is known about the completion rates of the liver-first approach and itseffects on survival.Methods:A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis.The primary outcome was an assessment of the completion rates of the liver-first approach.Secondary outcomes included overall survival, causes of non-completion, and clinicopathologicdata.Results: Seventeen articles were amenable for inclusion and the total study population was 1041.The median completion rate for the total population was 80% (range 20–100). The median overallsurvival for the completion and non-completion groups was 45 (range 12–69) months and 13 (range10.5–25) months, respectively. Metadata showed a significant survival benefit for the completiongroup, with a univariate hazard ratio of 12.0 (95% confidence interval, range 5.7–24.4). The majorcause of non-completion (76%) was liver disease progression before resection of the primarytumor. Pearson tests showed significant negative correlation between median number of lesionsand median size of the largest metastasis and completion rate.Conclusions: The liver-first approach offers a complete resection to most patients enrolled, withan overall survival benefit when completion can be assured. One-fifth fails to return to intendedoncologic therapy and the major cause is interim metastatic progression, most often in the liver.Risk of non-completion is related to a higher number of lesions and large metastases. The majorityof studies stem from primary

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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