Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis.

Abstract

Background: Previous meta-analyses have yielded conflicting results on the optimal surgical treatment strategy in patients with synchronous colorectal liver metastases (sCRLM). This network meta-analysis aims to provide an overview on colorectal-, liver first and simultaneous resections to treat sCRLM.

Methods: A search was conducted in MEDLINE, Embase and Cochrane CENTRAL (inception-July 11,2023). Pairwise and network meta-analyses were conducted to compare the three strategies, using colorectal-first resections as reference group.

Results: Overall, 46 studies with a total of 20,991 patients were included, a significant portion at a high risk of bias. Simultaneous resections were associated with less blood loss (MD -145.44 ml, 95%CI -239.40 to -51.48) and shorter hospital stays (MD -6.39 days, 95%CI -7.78 to -4.99). Liver-first resections were associated with more transfusions (OR 1.89, 95%CI 1.04 to 3.42) and shorter hospital stays (MD -4.53 days, 95%CI -7.99 to -1.06). Simultaneous resections were associated with less incomplete macroscopic disease clearances (OR 0.33, 95%CI 0.12 to 0.92), while liver-first resections were associated with more incomplete macroscopic disease clearances (OR 2.80, 95%CI 1.16 to 6.73) and less microscopically radical (R0) resections (OR 0.64, 95%CI 0.45 to 0.90). There were no significant differences in morbidity, mortality, disease-free or overall survival.

Conclusion: Based on meta-analysis of mainly observational studies, simultaneous resections were associated with less blood loss, shorter length of stay and more complete macroscopic disease clearances.