SURGICAL MANAGEMENT IN PATIENTS WITH SYNCHRONOUS COLORECTAL LIVER METASTASES – A SYSTEMATIC REVIEW AND META–ANALYSIS

V J Allu; S Basu; A K Shrestha; P S Basnyat; A Chowdhury

Volume : VIII, Issue : IX, September - 2018

SURGICAL MANAGEMENT IN PATIENTS WITH SYNCHRONOUS COLORECTAL LIVER METASTASES – A SYSTEMATIC REVIEW AND META–ANALYSIS

V J Allu, S Basu, A K Shrestha, P S Basnyat, A Chowdhury

Abstract :

While colorectal cancer is a major contributor to morbidity and mortality in the Caucasian population, there is a significant incidence of synchronous liver metastases (SCLM) in patients presenting with colorectal cancer. Surgery is the mainstay in management of colorectal cancer and is performed predominantly with a curative intent. The timing and sequencing of the surgical resection of tumour and the metastases has been established as highly important in improving prognosis. However, there is limited information around the effectiveness of each approach. The current review aims to identify data around simultaneous and staged resection in patients with SCLM to evaluate if there is a significant difference in either approach. PubMED and EASE’s searcher® database were searched, a modified PRISMA checklist was used to identify relevant data from the search results and fifteen studies were finalized to be included in the quantitative analysis, defined by inclusion and exclusion criteria, and scored with the use of MINORS criteria. Various outcomes of interest are analysed and Meta–analysis is performed with the use of Odds Ratio or Weighted Mean Difference. In conclusion, it is noted that the analysis did not show a statistically significant difference in the outcomes with either intervention. There are distinct methods of thought around which method to employ in various patient scenarios, and this is left to the discretion of the treating specialist. Research suggests further enquiry into the use of neoadjuvant and adjuvant chemotherapy to treat the underlying metastases in association with the primary tumor.