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Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The optimal timing of surgical resection for synchronous colorectal liver metastases (SCLMs) remains controversial. The aim of this metaanalysis was to compare outcomes between simultaneous resection and staged resection from all published comparative studies in the literature.

Materials and methods

Databases, including PubMed, Embase, Cochrane Library, Ovid, and Web of Science, were searched to identify studies comparing outcomes following simultaneous resection with staged resection for SCLM. The metaanalysis was performed by RevMan 4.2.

Results

Fourteen comparative studies comprising 2,204 patients were identified. Patients undergoing simultaneous resection were found to have similar operative time (weighted mean difference [WMD], −34.19; 95% confidence interval [CI], −81.32–12.95, P = .16) and intraoperative blood loss (WMD, −161.33; 95% CI, −351.45–28.79, P = .10). Shorter hospital stay (WMD, −4.77; 95% CI, −7.26–2.28, P < .01) and lower morbidity rate (odds ratio [OR], 0.71; 95% CI, 0.57–0.88, P = .002) were observed in simultaneous resection group. The survival rate in the simultaneous resection group did not statistically differ with that in the staged resection group at 1 year (OR, 0.77; 95% CI, 0.51–1.16, P = .21), 3 years (OR, 1.12; 95% CI, 0.85–1.47, P = .43), and 5 years (OR, 1.14; 95% CI, 0.86–1.50, P = .37) postresection, respectively.

Conclusions

Simultaneous resection is safe and efficient in the treatment of patients with SCLM while avoiding a second major operation. In appropriately selected patients, simultaneous resection might be considered as the preferred treatment. Since heterogeneity was detected, caution is needed in interpretation of the results. Better designed, adequately powered studies are required for addressing this issue.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Abdominal Surgery, Cancer Hospital, Fudan University, no. 270 Dong-An Road, Shanghai, 200032, People’s Republic of China

    Jinggui Chen, Changjian Wang, Huiyan Zhu, Yingqiang Shi & Guangfa Zhao

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China

    Jinggui Chen, Changjian Wang, Huiyan Zhu, Yingqiang Shi & Guangfa Zhao

  3. Department of General Surgery, Subei People’s Hospital of Jiangsu Province, Yangzhou, Jiangsu, People’s Republic of China

    Qingguo Li

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  1. Jinggui Chen
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Correspondence to Guangfa Zhao.

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Chen, J., Li, Q., Wang, C. et al. Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis. Int J Colorectal Dis 26, 191–199 (2011). https://doi.org/10.1007/s00384-010-1018-2

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  • DOI: https://doi.org/10.1007/s00384-010-1018-2

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