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Chirurgie 9. Dezember 2014

Comparison between simultaneous resection and staged resection of synchronous colorectal cancer with resectable liver metastases: a meta-analysis

Background: Previously, the surgical management of synchronous colorectal liver metastases has been a staged resection. Now, it is shifting toward the simultaneous resection of colorectal primary and liver metastases. The aim of this study is to compare the outcomes between simultaneous resection and staged resection.

Methods: The studies were identified searching the database including PubMed, Medline, and Cochrane library. The pooled odds ratios (OR) or weighted mean differences (WMD) with 95 % confidence interval (CI) were calculated using either the fixed effect or random effect model.

Results: A total of 20 studies were included with 3194 patients: 1137 to simultaneous resection group and 2057 to staged resection group. The overall survival at 1 year (OR = 0.73, 95 % CI = 0.48–1.11, P = 0.14), 3 year (OR = 1.13, 95 % CI = 0.88–1.44, P = 0.34), and 5 year (OR = 1.08, 95 % CI = 0.84–1.38, P = 0.54) and disease-free survival at 1 year (OR = 0.77, 95 % CI = 0.47–1.2, P = 0.29), 3 year (OR = 0.72, 95 % CI = 0.44–1.18, P = 0.19), and 5 year (OR = 0.60, 95 % CI = 0.34–1.04, P = 0.07) showed no significant difference between the two groups. The operative time (WMD = − 38.61, 95 % CI = − 89.26–12.04, P = 0.14), and postoperative recurrence (OR = 0.86, 95 % CI = 0.58–1.29, P = 0.47) were similar between the two groups. Shorter hospital stay (WMD = 5.49, 95 % CI = − 7.04 to − 3.94, P = 0.00001) and lower overall complication rate (OR = 0.73, 95 % CI = 0.61–0.87, P = 0.0004) were observed in simultaneous resection group.

Conclusion: In appropriately selected patients, simultaneous resection might be considered as the preferred treatment. Simultaneous resection is safe and efficient in the treatment of these patients with the elimination of second major operation.

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