Timing of hepatectomy for resectable synchronous colorectal liver metastases: for whom simultaneous resection is more suitable--a meta-analysis.
Timing of hepatectomy for resectable synchronous colorectal liver metastases: for whom simultaneous resection is more suitable--a meta-analysis.
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DOI：
10.1371/journal.pone.0104348
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Xu J
中科院分区：
文献类型：
--
作者：
Feng Q;Wei Y;Zhu D;Ye L;Lin Q;Li W;Qin X;Lyu M;Xu J
同时性结直肠癌肝转移的最佳切除时机仍有争议。回顾性队列研究在比较同期切除与分期策略时总是存在基线不平衡。明显更多的轻度疾病患者接受了同时切除。以前发表的基于这些研究的荟萃分析没有纠正这些偏倚，导致可靠性低。我们的荟萃分析是为了弥补这一缺陷，并找到每种手术策略的候选人。对2000年1月至2013年4月的主要数据库和相关期刊进行了系统检索。主要结局为术后死亡率、发病率、总生存率和无病生存率。还评估了其他结局，如需要输血的患者数量和住院时间。进行基线分析，以发现和纠正潜在的混杂因素。最终纳入了22项研究，共计4494例患者。校正基线失衡后，同期和分期切除术在术后死亡率（RR = 1.14，P = 0.52）、发病率（RR = 1.02，P = 0.85）、总生存率（HR = 0.96，P = 0.50）和无病生存率（HR = 0.97，P = 0.87）方面相似。 仅在肺部并发症方面，同期切除术具有显著优势（RR = 0.23，P = 0.003）。 肝转移瘤的数目是影响手术策略选择的主要因素。对于>3个转移灶，同时和分期策略的发病率几乎相同（49.4% vs. 50.9%）。对于≤3个转移灶，分期切除导致较低的发病率（13.8% vs. 17.2%），无统计学显著性。肝转移瘤的数量是术后发病率的主要混杂因素，尤其是在分期切除术中。在没有基线失衡的情况下，同步在安全性和有效性方面没有统计学显著优势。考虑到该荟萃分析的固有局限性，应谨慎解释和应用结果。
The optimal timing of resection for synchronous colorectal liver metastases is still controversial. Retrospective cohort studies always had baseline imbalances in comparing simultaneous resection with staged strategy. Significantly more patients with mild conditions received simultaneous resections. Previous published meta-analyses based on these studies did not correct these biases, resulting in low reliability. Our meta-analysis was conducted to compensate for this deficiency and find candidates for each surgical strategy. A systemic search for major databases and relevant journals from January 2000 to April 2013 was performed. The primary outcomes were postoperative mortality, morbidity, overall survival and disease-free survival. Other outcomes such as number of patients need blood transfusion and length of hospital stay were also assessed. Baseline analyses were conducted to find and correct potential confounding factors. 22 studies with a total of 4494 patients were finally included. After correction of baseline imbalance, simultaneous and staged resections were similar in postoperative mortality (RR = 1.14, P = 0.52), morbidity (RR = 1.02, P = 0.85), overall survival (HR = 0.96, P = 0.50) and disease-free survival (HR = 0.97, P = 0.87). Only in pulmonary complications, simultaneous resection took a significant advantage (RR = 0.23, P = 0.003). The number of liver metastases was the major factor interfering with selecting surgical strategies. With >3 metastases, simultaneous and staged strategies were almost the same in morbidity (49.4% vs. 50.9%). With ≤3 metastases, staged resection caused lower morbidity (13.8% vs. 17.2%), not statistically significant. The number of liver metastases was the major confounding factor for postoperative morbidity, especially in staged resections. Without baseline imbalances, simultaneous took no statistical significant advantage in safety and efficacy. Considering the inherent limitations of this meta-analysis, the results should be interpret and applied prudently.
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