1. Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review.
- Author
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Milazzo, Martina, Todeschini, Letizia, Caimano, Miriam, Mattia, Amelia, Cristin, Luca, Martinino, Alessandro, Bianco, Giuseppe, Spoletini, Gabriele, and Giovinazzo, Francesco
- Subjects
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LIVER tumors , *PATIENT selection , *COLORECTAL cancer , *TREATMENT effectiveness , *METASTASIS , *SYSTEMATIC reviews , *MEDLINE , *DISEASES , *MEDICAL databases , *QUALITY assurance , *PROGRESSION-free survival , *OVERALL survival - Abstract
Simple Summary: Colorectal cancer is a leading cause of death worldwide, with a significant number of patients presenting with liver metastases at diagnosis. The best treatment currently involves the surgical removal of these metastases, yet the optimal timing and method for this surgery are still debated among experts. Our analysis revealed no significant difference in overall survival and disease-free survival between a simultaneous surgery approach and a "bowel-first" approach, while a better 5-year overall survival (5-OS) was found when comparing the former to a "liver-first" approach. However, simultaneous surgeries are associated with a higher risk of perioperative mortality, suggesting that staged surgery might be more beneficial for high-risk patients. This emphasizes the need for personalized treatment plans. Our findings also suggest that anatomic and non-anatomic resections offer similar long-term survival benefits, highlighting the potential for more conservative surgeries to preserve liver function without compromising the effectiveness of cancer treatment. Surgical resection is the gold standard for treating synchronous colorectal liver metastases (CRLM). The resection of the primary tumor and metastatic lesions can follow different sequences: "simultaneous", "bowel-first", and "liver-first". Conservative approaches, such as parenchymal-sparing surgery and segmentectomy, may serve as alternatives to major hepatectomy. A comprehensive search of Medline, Epistemonikos, Scopus, and the Cochrane Library was conducted. Studies evaluating patients who underwent surgery for CRLM and reported survival results were included. Other secondary outcomes were analyzed, including disease-free survival, perioperative complications and mortality, and recurrence rates. Quality assessment was performed using the AMSTAR-2 method. No significant differences in overall survival, disease-free survival, and secondary outcomes were observed when comparing simultaneous to "bowel-first" resections, despite a higher rate of perioperative mortality in the former group. The 5-year OS was significantly higher for simultaneous resection compared to "liver-first" resection. No significant differences in OS and DFS were noted when comparing "liver-first" to "bowel-first" resection, or anatomic to non-anatomic resection. Our umbrella review validates simultaneous surgery as an effective oncological approach for treating SCRLM, though the increased risk of perioperative morbidity highlights the importance of selecting suitable patients. Non-anatomic resections might be favored to preserve liver function and enable future surgical interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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