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The liver-first approach for synchronous colorectal liver metastases: A systematic review and meta-analysis of completion rates and effects on survival

Zeyara, Adam LU orcid ; Torén, William LU ; Søreide, Kjetil and Andersson, Roland LU (2021) In Scandinavian Journal of Surgery
Abstract
Background: Patients presenting with synchronous colorectal liver metastases are increasingly
being considered for a curative treatment, and the liver-first approach is gaining popularity in this
context. However, little is known about the completion rates of the liver-first approach and its
effects on survival.
Methods:A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis.
The primary outcome was an assessment of the completion rates of the liver-first approach.
Secondary outcomes included overall survival, causes of non-completion, and clinicopathologic
data.
Results: Seventeen articles were amenable for inclusion and the total study population was 1041.
The... (More)
Background: Patients presenting with synchronous colorectal liver metastases are increasingly
being considered for a curative treatment, and the liver-first approach is gaining popularity in this
context. However, little is known about the completion rates of the liver-first approach and its
effects on survival.
Methods:A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis.
The primary outcome was an assessment of the completion rates of the liver-first approach.
Secondary outcomes included overall survival, causes of non-completion, and clinicopathologic
data.
Results: Seventeen articles were amenable for inclusion and the total study population was 1041.
The median completion rate for the total population was 80% (range 20–100). The median overall
survival for the completion and non-completion groups was 45 (range 12–69) months and 13 (range
10.5–25) months, respectively. Metadata showed a significant survival benefit for the completion
group, with a univariate hazard ratio of 12.0 (95% confidence interval, range 5.7–24.4). The major
cause of non-completion (76%) was liver disease progression before resection of the primary
tumor. Pearson tests showed significant negative correlation between median number of lesions
and median size of the largest metastasis and completion rate.
Conclusions: The liver-first approach offers a complete resection to most patients enrolled, with
an overall survival benefit when completion can be assured. One-fifth fails to return to intended
oncologic therapy and the major cause is interim metastatic progression, most often in the liver.
Risk of non-completion is related to a higher number of lesions and large metastases. The majority
of studies stem from primary (Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Surgery
article number
14574969211030131
publisher
Finnish Surgical Society
external identifiers
  • pmid:34605325
  • scopus:85116335868
ISSN
1799-7267
DOI
10.1177/14574969211030131
language
English
LU publication?
yes
id
0a69d701-9393-4d78-a737-88a3d5f7270d
date added to LUP
2021-10-27 21:13:48
date last changed
2022-08-05 08:19:58
@article{0a69d701-9393-4d78-a737-88a3d5f7270d,
  abstract     = {{Background: Patients presenting with synchronous colorectal liver metastases are increasingly<br/>being considered for a curative treatment, and the liver-first approach is gaining popularity in this<br/>context. However, little is known about the completion rates of the liver-first approach and its<br/>effects on survival.<br/>Methods:A systematic review and meta-analysis of liver-first strategy for colorectal liver metastasis.<br/>The primary outcome was an assessment of the completion rates of the liver-first approach.<br/>Secondary outcomes included overall survival, causes of non-completion, and clinicopathologic<br/>data.<br/>Results: Seventeen articles were amenable for inclusion and the total study population was 1041.<br/>The median completion rate for the total population was 80% (range 20–100). The median overall<br/>survival for the completion and non-completion groups was 45 (range 12–69) months and 13 (range<br/>10.5–25) months, respectively. Metadata showed a significant survival benefit for the completion<br/>group, with a univariate hazard ratio of 12.0 (95% confidence interval, range 5.7–24.4). The major<br/>cause of non-completion (76%) was liver disease progression before resection of the primary<br/>tumor. Pearson tests showed significant negative correlation between median number of lesions<br/>and median size of the largest metastasis and completion rate.<br/>Conclusions: The liver-first approach offers a complete resection to most patients enrolled, with<br/>an overall survival benefit when completion can be assured. One-fifth fails to return to intended<br/>oncologic therapy and the major cause is interim metastatic progression, most often in the liver.<br/>Risk of non-completion is related to a higher number of lesions and large metastases. The majority<br/>of studies stem from primary}},
  author       = {{Zeyara, Adam and Torén, William and Søreide, Kjetil and Andersson, Roland}},
  issn         = {{1799-7267}},
  language     = {{eng}},
  month        = {{10}},
  publisher    = {{Finnish Surgical Society}},
  series       = {{Scandinavian Journal of Surgery}},
  title        = {{The liver-first approach for synchronous colorectal liver metastases: A systematic review and meta-analysis of completion rates and effects on survival}},
  url          = {{http://dx.doi.org/10.1177/14574969211030131}},
  doi          = {{10.1177/14574969211030131}},
  year         = {{2021}},
}