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

Zeyara, Adam (author)
Lund University,Lunds universitet,Kirurgi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Surgery (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Ystad Hospital
Torén, William (author)
Lund University,Lunds universitet,Lever-, pankreas- och gallvägskirurgi,Forskargrupper vid Lunds universitet,Hepato-Pancreato-Biliary Surgery,Lund University Research Groups
Søreide, Kjetil (author)
Stavanger University Hospital,University of Bergen
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Andersson, Roland (author)
Lund University,Lunds universitet,Lever-, pankreas- och gallvägskirurgi,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Hepato-Pancreato-Biliary Surgery,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments
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 (creator_code:org_t)
2021-10-03
2021
English.
In: Scandinavian Journal of Surgery. - : SAGE Publications. - 1799-7267 .- 1457-4969.
  • Research review (peer-reviewed)
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  • 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

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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Zeyara, Adam
Torén, William
Søreide, Kjetil
Andersson, Rolan ...
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MEDICAL AND HEALTH SCIENCES
MEDICAL AND HEAL ...
and Clinical Medicin ...
and Surgery
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Scandinavian Jou ...
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Lund University

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