Synchronous Colorectal Liver Metastasis: A Network Meta-Analysis Review Comparing Classical, Combined, and Liver-First Surgical Strategies

BackgroundIn recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal-first approach have been proposed. These include the liver-first and combined resections approaches. The objectives of this review were to compare the short- and long-term outcomes for all three approaches. MethodsA systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5-year overall survival, 30-day mortality, and post-operative complications). Pair-wise and network meta-analysis (NMA) were performed to compare survival outcomes. ResultsEighteen studies were included in this review, reporting on 3,605 patients. NMA and pair-wise meta-analysis of the 5-year overall survival did not show significant difference between the three surgical approaches: combined versus colorectal-first, mean odds ratio (OR) 1.02 (95% CI 0.8-1.28, P=0.93); liver-first versus colorectal-first, mean OR 0.81 (95% CI 0.53-1.26, P=0.37); liver-first versus combined, mean OR 0.80 (95% CI 0.52-1.24, P=0.41). In addition NMA of the 30-day mortality among the three approaches also did not observe statistical difference. Analysis of variance showed that mean post-operative complications of all approaches were comparable (P=0.51). ConclusionThere are considerable differences in the peri-operative management of synchronous CLM patients. This meta-analysis demonstrated no clear statistical surgical outcome or survival advantage towards any of the three approaches. J. Surg. Oncol. 2015 111:341-351. (c) 2014 Wiley Periodicals, Inc.