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

被引:67
作者
Chen, Jinggui [1 ,2 ]
Li, Qingguo [3 ]
Wang, Changjian [1 ,2 ]
Zhu, Huiyan [1 ,2 ]
Shi, Yingqiang [1 ,2 ]
Zhao, Guangfa [1 ,2 ]
机构
[1] Fudan Univ, Canc Hosp, Dept Abdominal Surg, Shanghai 200032, Peoples R China
[2] Fudan Univ, Shanghai Med Coll, Dept Oncol, Shanghai 200032, Peoples R China
[3] Subei Peoples Hosp Jiangsu Prov, Dept Gen Surg, Yangzhou, Jiangsu, Peoples R China
关键词
Simultaneous liver resection; Staged liver resection; Synchronous liver metastases; Colorectal cancer; Metaanalysis; HEPATIC RESECTION; CANCER; HEPATECTOMY; CARCINOMA; SURVIVAL; PROGNOSIS; TUMOR;
D O I
10.1007/s00384-010-1018-2
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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. 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. 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. 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.
引用
收藏
页码:191 / 199
页数:9
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