Resection of colorectal liver metastases and extra-hepatic disease: a systematic review and proportional meta-analysis of survival outcomes

William J Hadden, Philip R de Reuver, Kai Brown, Anubhav Mittal, Jaswinder S Samra, Thomas J Hugh, William J Hadden, Philip R de Reuver, Kai Brown, Anubhav Mittal, Jaswinder S Samra, Thomas J Hugh

Abstract

Background: Colorectal cancer (CRC) accounts for 9.7% of all cancers with 1.4 million new cases diagnosed each year. 19-31% of CRC patients develop colorectal liver metastases (CRLM), and 23-38% develop extra-hepatic disease (EHD). The aim of this systematic review was to determine overall survival (OS) in patients resected for CRLM and known EHD.

Methods: A systematic review was undertaken to identify studies reporting OS after resection for CRLM in the presence of EHD. Proportional meta-analyses and relative risk of death before five years were assessed between patient groups.

Results: A total of 15,144 patients with CRLM (2308 with EHD) from 52 studies were included. Three and 5-year OS were 58% and 26% for lung, 37% and 17% for peritoneum, and 35% and 15% for lymph nodes, respectively. The combined relative risk of death by five years was 1.49 (95% CI = 1.34-1.66) for lung, 1.59 (95% CI = 1.16-2.17) for peritoneal and 1.70 (95% CI = 1.57-1.84) for lymph node EHD, in favour of resection in the absence of EHD.

Conclusion: This review supports attempts at R0 resection in selected patients and rejects the notion that EHD is an absolute contraindication to resection.

Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Search strategy applied to PubMed database
Figure 2
Figure 2
Proportional meta-analyses of three and 5-year overall survival in patients resected for CRLM and EHD in the (a) lung,, , , , , , , , (b) peritoneum, , , , , , , , , , and (c) lymph nodes, , , , , , , , , ,
Figure 3
Figure 3
Forest plot comparing 5-year overall survival in patients resected for CRLM without EHD versus patients resected for both CRLM and EHD in the (a) lung,, , (b) peritoneum, , , and (c) lymph nodes, , , , , ,
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4814625/bin/fx1.jpg

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