M D Smith1, J L McCall. 1. Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
Abstract
BACKGROUND: Resection of colorectal liver metastases (CLMs) is potentially curative but the effect of tumour number on prognosis is uncertain. This study compared the prognosis after resection and/or ablation of between one and three, or four or more CLMs. METHODS: A systematic literature review from January 2000 to June 2008 was performed. Study selection and data extraction were standardized, and analysis included assessment of methodological quality, heterogeneity and bias. Main outcomes were 3- and 5-year survival. A meta-analysis comparing radical treatment in the two groups was performed using the hazard ratio for overall survival. RESULTS: Of 1307 studies screened, 46 (9934 patients) were included in the analysis. Methodological quality was variable, and there was significant heterogeneity and reporting bias. The overall 5-year survival rate after radical treatment ranged from 7 to 58 per cent. Pooled hazard ratio for overall survival was 1.67 (95 per cent confidence interval 1.43 to 1.95; P < 0.001). Median reported 5-year survival for patients with four or more CLMs was 17.1 per cent. CONCLUSION: Radical treatment of more than three CLMs results in poorer overall survival. Nevertheless, 5-year survival is achievable and the number of lesions should not, of itself, be used to exclude patients from surgery.
BACKGROUND: Resection of colorectal liver metastases (CLMs) is potentially curative but the effect of tumour number on prognosis is uncertain. This study compared the prognosis after resection and/or ablation of between one and three, or four or more CLMs. METHODS: A systematic literature review from January 2000 to June 2008 was performed. Study selection and data extraction were standardized, and analysis included assessment of methodological quality, heterogeneity and bias. Main outcomes were 3- and 5-year survival. A meta-analysis comparing radical treatment in the two groups was performed using the hazard ratio for overall survival. RESULTS: Of 1307 studies screened, 46 (9934 patients) were included in the analysis. Methodological quality was variable, and there was significant heterogeneity and reporting bias. The overall 5-year survival rate after radical treatment ranged from 7 to 58 per cent. Pooled hazard ratio for overall survival was 1.67 (95 per cent confidence interval 1.43 to 1.95; P < 0.001). Median reported 5-year survival for patients with four or more CLMs was 17.1 per cent. CONCLUSION: Radical treatment of more than three CLMs results in poorer overall survival. Nevertheless, 5-year survival is achievable and the number of lesions should not, of itself, be used to exclude patients from surgery.
Authors: A A J M Van Tilborg; M R Meijerink; C Sietses; J H T M Van Waesberghe; M O Mackintosh; S Meijer; C Van Kuijk; P Van Den Tol Journal: Br J Radiol Date: 2010-12-15 Impact factor: 3.039
Authors: Wong Hoi She; Albert C Y Chan; Ka Wing Ma; Wing Chiu Dai; Kenneth S H Chok; Tan To Cheung; Chung Mau Lo Journal: J Gastrointest Surg Date: 2018-06-29 Impact factor: 3.452
Authors: Konrad Mohnike; Steffen Wolf; Robert Damm; Max Seidensticker; Ricarda Seidensticker; Frank Fischbach; Nils Peters; Peter Hass; Günther Gademann; Maciej Pech; Jens Ricke Journal: Strahlenther Onkol Date: 2016-02-29 Impact factor: 3.621
Authors: Susan Tsai; Hugo P Marques; Mechteld C de Jong; Paulo Mira; Vasco Ribeiro; Michael A Choti; Richard D Schulick; Eduardo Barroso; Timothy M Pawlik Journal: HPB (Oxford) Date: 2010-05 Impact factor: 3.647
Authors: Florian Sterzing; Thomas B Brunner; Iris Ernst; Wolfgang W Baus; Burkhard Greve; Klaus Herfarth; Matthias Guckenberger Journal: Strahlenther Onkol Date: 2014-08-05 Impact factor: 3.621
Authors: Ilia Gur; Brian S Diggs; Jesse A Wagner; Gina M Vaccaro; Charles D Lopez; Brett C Sheppard; Susan L Orloff; Kevin G Billingsley Journal: J Gastrointest Surg Date: 2013-10-04 Impact factor: 3.452
Authors: Karin Nielsen; Aukje A J M van Tilborg; Martijn R Meijerink; Matessa O Macintosh; Babs M Zonderhuis; Elly S M de Lange; Emile F I Comans; Sybren Meijer; M Petrousjka van den Tol Journal: World J Surg Date: 2013-06 Impact factor: 3.352