Management of Colorectal Cancer with Synchronous Liver Metastases: A systematic review of national and International Clinical Guidelines (CoSMIC-G)

IF 1.4 Q3 SURGERY Surgery open science Pub Date : 2024-10-31 DOI:10.1016/j.sopen.2024.10.009

Anthony K.C. Chan PhD FRCS, Ajith K. Siriwardena MD FRCS

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Abstract

Introduction

The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. This study appraises the recommendations made by national/international guidelines for the diagnosis and management of patients with synchronous liver metastases from colorectal cancer.

Methods

A systematic review of national and international guidelines published between 2011 and 2024 was carried out using PubMed, OvidSP and Guidelines International Network databases. The quality of guidelines was evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidelines were assessed for the quality of advice for specific scenarios. The protocol was registered with PROSPERO (CRD42021243744).

Results

The search strategy returned ninety unique articles with 11 guidelines eligible for inclusion. Of these, one (9 %) guideline defined ‘synchronous disease’ at outset, eight (73 %) recommended neoadjuvant chemotherapy as first intervention. Seven (64 %) guidelines supported synchronous hepatic resection with colectomy. One (9 %) recommended against synchronous surgery.

Conclusions

This study demonstrates important variations between international clinical guidelines on diagnostic workup and management of synchronous liver metastases in colorectal cancer. [167 words].

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大肠癌同步肝转移的管理：国家和国际临床指南系统回顾 (CoSMIC-G)

导言当代结直肠癌同步肝转移患者的管理非常复杂。本研究评估了国家/国际指南对结直肠癌同步肝转移患者的诊断和管理提出的建议。方法利用PubMed、OvidSP和指南国际网络数据库对2011年至2024年间发布的国家和国际指南进行了系统性回顾。使用研究与amp; 评估指南鉴定 II (AGREE II) 工具对指南质量进行评估。对指南进行了评估，以确定针对特定情况提出的建议的质量。该方案已在 PROSPERO（CRD42021243744）上注册。其中，1 份（9%）指南从一开始就定义了 "同步疾病"，8 份（73%）指南建议将新辅助化疗作为首次干预。七份（64%）指南支持同步肝切除和结肠切除术。结论这项研究表明，国际临床指南在结直肠癌同步肝转移的诊断和管理方面存在重大差异。[167字]。

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