Simultaneous, Delayed and Liver-First Hepatic Resections for Synchronous Colorectal Liver Metastases: A Systematic Review and Network Meta-Analysis.
Delayed
Hepatectomy
Liver resection
Liver-first
Simultaneous
Synchronous colorectal liver metastases
Journal
Journal of clinical medicine research
ISSN: 1918-3003
Titre abrégé: J Clin Med Res
Pays: Canada
ID NLM: 101538301
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
25
05
2019
accepted:
17
06
2019
entrez:
16
8
2019
pubmed:
16
8
2019
medline:
16
8
2019
Statut:
ppublish
Résumé
Systematic reviews and meta-analyses that compare simultaneous, delayed and liver-first approach for synchronous colorectal liver metastases have found no significant differences. The aim of this study was to determine the best treatment strategy on the basis of effect sizes and the probabilities of treatment ranking by using a network meta-analysis. Moreover, first-time pairwise and network meta-analyses were used to estimate the existing evidence, and their results were compared to detect any discrepancies between them. Systematic review, pairwise meta-analysis and network meta-analysis were performed. The primary and secondary outcomes were 5-year overall survival and postoperative major morbidity, respectively. No significant differences in long-term survival and major morbidity were found amongst the three approaches. The hazard ratios (95% confidence interval) for 5-year overall survival for the simultaneous, delayed and liver-first approaches were 0.93 (0.69 - 1.24, P = 0.613), 0.97 (0.87 - 1.07, P = 0.596) and 0.90 (0.67 - 1.22, P = 0.499), respectively. Moreover, the liver-first approach with a surface under the cumulative ranking area score of 89% was ranked as the potentially best treatment option based on probabilities of treatment ranking. On the basis of the relative ranking of treatments, the liver-first approach ranked first, followed by the delayed and simultaneous approaches. Therefore, a three-arm randomized controlled trial that compares the liver-first, simultaneous and delayed approaches needs to shed further light as to which is the best treatment option.
Sections du résumé
BACKGROUND
BACKGROUND
Systematic reviews and meta-analyses that compare simultaneous, delayed and liver-first approach for synchronous colorectal liver metastases have found no significant differences. The aim of this study was to determine the best treatment strategy on the basis of effect sizes and the probabilities of treatment ranking by using a network meta-analysis. Moreover, first-time pairwise and network meta-analyses were used to estimate the existing evidence, and their results were compared to detect any discrepancies between them.
METHODS
METHODS
Systematic review, pairwise meta-analysis and network meta-analysis were performed. The primary and secondary outcomes were 5-year overall survival and postoperative major morbidity, respectively.
RESULTS
RESULTS
No significant differences in long-term survival and major morbidity were found amongst the three approaches. The hazard ratios (95% confidence interval) for 5-year overall survival for the simultaneous, delayed and liver-first approaches were 0.93 (0.69 - 1.24, P = 0.613), 0.97 (0.87 - 1.07, P = 0.596) and 0.90 (0.67 - 1.22, P = 0.499), respectively. Moreover, the liver-first approach with a surface under the cumulative ranking area score of 89% was ranked as the potentially best treatment option based on probabilities of treatment ranking.
CONCLUSIONS
CONCLUSIONS
On the basis of the relative ranking of treatments, the liver-first approach ranked first, followed by the delayed and simultaneous approaches. Therefore, a three-arm randomized controlled trial that compares the liver-first, simultaneous and delayed approaches needs to shed further light as to which is the best treatment option.
Identifiants
pubmed: 31413769
doi: 10.14740/jocmr3887
pmc: PMC6681858
doi:
Types de publication
Journal Article
Langues
eng
Pagination
572-582Déclaration de conflit d'intérêts
All the authors declare that they have no conflict of interest.
Références
Chirurgie. 1999 Jun;124(3):258-63
pubmed: 10429299
Br J Surg. 2003 Aug;90(8):956-62
pubmed: 12905548
Surgery. 2004 Sep;136(3):650-9
pubmed: 15349115
Stat Med. 2004 Oct 30;23(20):3105-24
pubmed: 15449338
Dis Colon Rectum. 2004 Aug;47(8):1310-6
pubmed: 15484344
Pharmacoeconomics. 2006;24(1):1-19
pubmed: 16445299
J Nippon Med Sch. 2006 Apr;73(2):82-8
pubmed: 16641532
Br J Surg. 2006 Jul;93(7):872-8
pubmed: 16671066
Ann Surg. 2006 Aug;244(2):254-9
pubmed: 16858188
Arch Surg. 2006 Oct;141(10):1006-12; discussion 1013
pubmed: 17043279
Ann Surg Oncol. 2007 Mar;14(3):1143-50
pubmed: 17200913
Int J Colorectal Dis. 2007 Oct;22(10):1269-76
pubmed: 17318552
Eur J Surg Oncol. 2007 Aug;33(6):735-40
pubmed: 17400418
World J Gastroenterol. 2007 Mar 7;13(9):1431-4
pubmed: 17457976
World J Surg. 2007 Jul;31(7):1496-501
pubmed: 17534545
Ann Surg Oncol. 2007 Dec;14(12):3481-91
pubmed: 17805933
Ann Surg. 2008 Jan;247(1):125-35
pubmed: 18156932
J Gastrointest Surg. 2008 Aug;12(8):1391-8
pubmed: 18491195
Surgery. 1991 Jul;110(1):13-29
pubmed: 1866690
J Am Coll Surg. 2009 May;208(5):842-50; discussion 850-2
pubmed: 19476847
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Ann Surg. 2009 Aug;250(2):187-96
pubmed: 19638912
World J Surg. 1991 Jan-Feb;15(1):62-7
pubmed: 1994607
Can J Surg. 2009 Dec;52(6):E241-4
pubmed: 20011158
Eur J Surg Oncol. 2010 Apr;36(4):365-70
pubmed: 20034757
Br J Surg. 2010 Mar;97(3):383-90
pubmed: 20101594
Dig Dis Sci. 2010 Nov;55(11):3262-70
pubmed: 20112062
J Am Coll Surg. 2010 Jun;210(6):934-41
pubmed: 20510802
Magy Onkol. 2010 Jun;54(2):125-8
pubmed: 20576588
Br J Surg. 2010 Aug;97(8):1279-89
pubmed: 20578183
J Gastrointest Surg. 2010 Dec;14(12):1974-80
pubmed: 20676791
J Clin Epidemiol. 2011 Feb;64(2):163-71
pubmed: 20688472
BMJ. 2010 Sep 16;341:c4675
pubmed: 20847017
J Am Coll Surg. 2012 Aug;215(2):262-70
pubmed: 22560316
Syst Rev. 2012 Jul 28;1:34
pubmed: 22839660
Ann Surg. 2012 Nov;256(5):772-8; discussion 778-9
pubmed: 23095621
J Am Coll Surg. 2013 Apr;216(4):707-16; discussion 716-8
pubmed: 23433970
Med Decis Making. 2013 Jul;33(5):618-40
pubmed: 23804507
G Chir. 2014 Mar-Apr;35(3-4):86-93
pubmed: 24841686
ANZ J Surg. 2015 Nov;85(11):829-33
pubmed: 24981795
J Surg Oncol. 2015 Mar;111(3):341-51
pubmed: 25363294
Dig Surg. 2015;32(1):16-22
pubmed: 25613745
Surg Today. 2016 Feb;46(2):176-82
pubmed: 26007322
Cancer Treat Rev. 2015 Nov;41(9):729-41
pubmed: 26417845
Surgery. 2016 Jul;160(1):67-73
pubmed: 27079362
Nat Rev Clin Oncol. 2017 May;14(5):297-315
pubmed: 27995949
HPB (Oxford). 2018 Jan;20(1):11-19
pubmed: 28888775
BMJ. 1997 Sep 13;315(7109):629-34
pubmed: 9310563
Stat Med. 1998 Dec 30;17(24):2815-34
pubmed: 9921604