Systematic review of outcomes of patients undergoing resection for colorectal liver metastases in the setting of extra hepatic disease
Systematic review of outcomes of patients undergoing resection for colorectal liver metastases in the setting of extra hepatic disease
复制标题
DOI：
10.1016/j.ejca.2014.03.277
复制
发表时间：
2014-07-01
影响因子：
8.4
通讯作者：
Turaga, Kiran K.
中科院分区：
文献类型：
--
作者：
Hwang, Michael;Jayakrishnan, Thejus T.;Turaga, Kiran K.
背景：结直肠癌肝转移（CRLM）患者的手术切除可为患者提供显著的生存获益。我们假设，CRLM和肝外疾病（EHD）患者进行肝切除术有可比的生存和描述的结果的基础上，转移diseases.Methods的分布：一个系统的搜索使用预定义的注册协议进行了2003年1月至2012年6月。主要暴露是CRLM的肝切除，主要结局指标是总生存期。荟萃回归技术被用来分析患者之间的差异，并没有extrahepatic diseases.Findings：从4996篇文章，50个保留数据提取（3481 CRLM患者EHD）。中位生存期（MS）为30.5（范围，9-98）个月，手术死亡率为0- 4.2%。3年和5年总生存率（OS）分别为42.4%（范围，20.6-77%）和28%（范围，0-61%）。肺EHD患者的MS为45（范围，39-98）个月，淋巴结（门静脉和主动脉旁）为26（范围，21-48）个月，腹膜为29（范围，18-32）个月。MS也因肝脏疾病的数量而异- 42.2个月（= 3个病灶）。解释：在不断发展的多模态治疗中，CRLM患者EHD的选择性肝切除术是可行的，对生存率有潜在影响。轻微肝病和肺部EHD的患者可获得最佳结局。(C)2014爱思唯尔有限公司版权所有。
Background: Surgical resection for patients with colorectal liver metastases (CRLM) can offer patients a significant survival benefit. We hypothesised that patients with CRLM and extra hepatic disease (EHD) undergoing metastasectomy had comparable survival and describe outcomes based on the distribution of metastatic disease.Methods: A systematic search using a predefined registered protocol was undertaken between January 2003 and June 2012. Primary exposure was hepatic resection for CRLM and primary outcome measure was overall survival. Meta-regression techniques were used to analyse differences between patients with and without extra hepatic disease.Findings: From a pool of 4996 articles, 50 were retained for data extraction (3481 CRLM patients with EHD). The median survival (MS) was 30.5 (range, 9-98) months which was achieved with an operative mortality rate of 0-4.2%. The 3-year and 5-year overall survival (OS) were 42.4% (range, 20.6-77%) and 28% (range, 0-61%) respectively. Patients with EHD of the lungs had a MS of 45 (range, 39-98) months versus lymph nodes (portal and para-aortic) 26 (range, 21-48) months versus peritoneum 29 (range, 18-32) months. The MS also varied by the amount of liver disease - 42.2 months (= three lesions).Interpretation: In the evolving landscape of multimodality therapy, selective hepatic resection for CRLM patients with EHD is feasible with potential impact on survival. Patients with minimal liver disease and EHD in the lung achieve the best outcome. (C) 2014 Elsevier Ltd. All rights reserved.