The Role of Preoperative Chemotherapy in the Management of Synchronous Resectable Colorectal Liver Metastases: A Meta-Analysis

被引:4
作者
Tepelenis, Kostas [1 ,2 ]
Pappas-Gogos, Georgios [1 ,2 ,3 ,4 ]
Ntellas, Panagiotis [5 ,6 ]
Tsimogiannis, Konstantinos [1 ,2 ]
Dadouli, Katerina [7 ]
Mauri, Davide [5 ,6 ]
Glantzounis, Georgios K. K. [1 ,2 ]
机构
[1] Univ Ioannina, Univ Hosp Ioannina, Hepatobiliary & Pancreat Surg HPB Unit, Ioannina 45110, Greece
[2] Univ Ioannina, Fac Med, Sch Hlth Sci, Ioannina 45110, Greece
[3] Democritus Univ Thrace, Gen Univ Hosp Alexandroupolis, Dept Surg 2, Alexandroupolis 69100, Greece
[4] Democritus Univ Thrace, Med Sch, Alexandroupolis 69100, Greece
[5] Univ Ioannina, Univ Hosp Ioannina, Dept Oncol, Ioannina 45110, Greece
[6] Univ Ioannina, Fac Med, Sch Hlth Sci, Ioannina 45110, Greece
[7] Univ Thessaly, Fac Med, Lab Hyg & Epidemiol, Larisa 38221, Greece
关键词
preoperative chemotherapy; neoadjuvant chemotherapy; synchronous colorectal liver metastases; resectable colorectal liver metastases; stage IV colorectal cancer; NEOADJUVANT CHEMOTHERAPY; HEPATIC RESECTION; SCORING SYSTEM; CLINICAL SCORE; CANCER; SURGERY; SURVIVAL; NUMBER;
D O I
10.3390/curroncol30050340
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The indications of preoperative chemotherapy, for initially resectable synchronous colorectal liver metastases, remain controversial. This meta-analysis aimed to assess the efficacy and safety of preoperative chemotherapy in such patients. Methods: Six retrospective studies were included in the meta-analysis with 1036 patients. Some 554 patients were allocated to the preoperative group, and 482 others were allocated to the surgery group. Results: Major hepatectomy was more common in the preoperative group than in the surgery group (43.1% vs. 28.8%, p < 0.001). Furthermore, the percentage of patients with more than three liver metastases was higher in the preoperative group compared to the surgery group (12.6% vs. 5.4%, p < 0.002). Preoperative chemotherapy showed no statistically significant impact on overall survival. Combined disease free/relapse survival analysis of patients with high disease burden (liver metastases > 3, maximum diameter > 5 cm, clinical risk score >= 3) demonstrated that there is a 12% lower risk of recurrence in favor of preoperative chemotherapy. Combined analysis showed a statistically significant (77% higher probability) of postoperative morbidity in patients who received preoperative chemotherapy (p = 0.002). Conclusions: Preoperative chemotherapy should be suggested in patients with high disease burden. The number of cycles of preoperative chemotherapy should be low (3-4) to avoid increased postoperative morbidity. However more prospective studies are needed to clarify the exact role of preoperative chemotherapy in patients with synchronous resectable colorectal liver metastases.
引用
收藏
页码:4499 / 4511
页数:13
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