Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021
Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021
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DOI：
10.1002/jhbp.868
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发表时间：
2020-12-12
影响因子：
3
通讯作者：
Takada，Tadahiro
中科院分区：
文献类型：
--
作者：
Yamamoto，Masakazu;Yoshida，Masahiro;Takada，Tadahiro
背景肝切除术是结直肠癌肝转移的标准治疗方法，但其他原发癌肝转移是否应切除尚不清楚。因此，日本肝胆胰外科学会创建了转移性肝tumors.MethodsEight原发性疾病的管理的临床实践指南，根据每年为每个恶性肿瘤进行肝切除术的数量。临床问题以人群、干预、比较和结局（皮科）格式构建。进行了系统评价，并讨论和确定了每个临床问题的建议强度和证据质量水平。分级的建议评估，发展和评价（GRADE）的方法被用来评估证据，并提出recommends.ResultsThe八个主要网站被分为五个类别的基础上，建议适应症肝切除术和共识的准则委员会。设计了14个临床问题，涵盖5个主题：（1）诊断，（2）手术治疗，（3）消融治疗，（4）8种原发疾病，（5）全身治疗。1个临床问题的推荐等级为强，其他13个临床问题的推荐等级为弱。两个问题的证据质量为中等，10个问题的证据质量为低，2个问题的证据质量为非常低。一个流程图总结了肝切除和全身治疗指征指南的结果。它们可能有助于进行未来的临床试验，以提供更高质量的证据。
BackgroundHepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato‐Biliary‐Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors.MethodsEight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations.ResultsThe eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two.A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy.ConclusionsThese guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher‐quality evidence.