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02.04.2019 | review

Simultaneous versus staged resection of rectal cancer and synchronous liver metastases (RESECT)

A systematic review and meta-analysis

European Surgery
Andrew E. Giles, Marlie Valencia, Sameer Parpia, Erin Fu, Leyo Ruo, Marko Simunovic, Dr. Pablo E. Serrano
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10353-019-0582-0) contains supplementary material, which is available to authorized users.

Presented at

1. Americas Hepato-Pancreatico-Biliary Association Meeting, Apr 2017. Miami Beach, Florida, USA.
2. Canadian Surgery Forum (Canadian Hepato-Pancreatico-Biliary Association), Sept 2017. Victoria, British Columbia, Canada.

Availability of data and material

The data analyzed for this manuscript are included in this article.

Authors’ contributions

AEG screened the articles found, entered the data into RevMan for the meta-analysis, and was a major contributor in manuscript preparation. MV conducted the initial literature search and served as the second data abstractor in screening the studies for inclusion. SP carried out the meta-analysis and ensured all data points were verified. EF served as the mediator of conflicts. LR helped with the initial design of the systematic review and manuscript preparation. MS contributed in manuscript preparation. PES also took part in designing the systematic review and manuscript preparation. All authors read and approved the final manuscript.

Publisher’s Note

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Staged resection is preferred to treat synchronous rectal cancer with liver metastases. Simultaneous resection of rectal cancer with synchronous liver metastases may potentially decrease postoperative complications, thereby improving quality of life, decreasing health care costs, and avoiding delays in postoperative chemotherapy administration. We evaluated the safety of simultaneous resection.


We searched Medline, Embase, and PubMed for studies comparing simultaneous versus staged resection. Study selection, data abstraction, risk of bias (ROB), and quality of the evidence (QOE) assessment were performed in duplicate. The primary outcome was overall postoperative complications. The secondary outcome was postoperative complications in the intervention group. ROB and QOE were assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).


4456 abstracts were retrieved; 18 retrospective cohort studies reported postoperative complications in the intervention arm, with six comparing intervention (288 patients) to control (287 patients). The odds ratio (OR) for overall complications was 0.93, 95% confidence interval (CI): 0.64–1.35, and for major complications was 0.77, 95%CI: 0.40–1.50. Proportion of complications (intervention arm): 41%, 95%CI: 33–50%. ROB was moderate.


Simultaneous resection of synchronous rectal cancer with liver metastases carries a similar risk of overall and major complications compared to the staged approach. However, QOE is very low and a simultaneous approach ought to be pursued only in selected patients until better evidence is available.

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SUPPLEMENT 1: MEDLINE Search strategy
SUPPLEMENT 2: EMBASE Search strategy
SUPPLEMENT 3: Summary of studies including primary outcome (comparison of overall complications between surgical approaches)
SUPPLEMENT 4: Systematic review risk of bias summary. Empty cell indicates item not assessable
SUPPLEMENT 5: GRADE Summary of findings for comparisons of primary (overall complications) and secondary (major complications) outcomes
SUPPLEMENT 6: GRADE evidence profile for comparisons of primary (overall complications) and secondary (major complications) outcomes
SUPPLEMENT 7: Single-arm analysis of overall postoperative complication rate among simultaneous resections
SUPPLEMENT 8: Single-arm analysis of major postoperative complications among simultaneous resections
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