Selecting patients for a second hepatectomy for colorectal metastases: An systemic review and meta-analysis
Abstract Background Opinions on the suitability of repeat hepatectomy for patients with recurrent colorectal liver metastases (CRLMs) vary among studies. We conducted a meta-analysis to establish the criteria for selecting the best candidates for a second hepatectomy. Methods Database and manual sea...
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| Veröffentlicht in: | European journal of surgical oncology 2014-09, Vol.40 (9), p.1036-1048 |
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| creator | Luo, L.X Yu, Z.Y Huang, J.W Wu, H |
| description | Abstract Background Opinions on the suitability of repeat hepatectomy for patients with recurrent colorectal liver metastases (CRLMs) vary among studies. We conducted a meta-analysis to establish the criteria for selecting the best candidates for a second hepatectomy. Methods Database and manual searches were performed to identify comparative or prognostic studies published up to October 2013. Outcomes of interest included disease characteristics, perioperative outcomes, and long-term survival after initial and second hepatectomies for patients with CRLM. Study quality was appraised using the Newcastle–Ottawa scale and a modified Hayden's score. Results A total of 7226 patients from 27 studies were included. Recurrent CRLMs after initial hepatectomy were more likely to be solitary (RR = 0.86, P = 0.045), unilobar (RR = 0.60, P |
| doi_str_mv | 10.1016/j.ejso.2014.03.012 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1564602031</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0748798314003667</els_id><sourcerecordid>1564602031</sourcerecordid><originalsourceid>FETCH-LOGICAL-c547t-eb1d04098729fe44df988faf2bfd7a8bffa3cdc612d3f89301b5bab4588579a13</originalsourceid><addsrcrecordid>eNp9kU2L1TAUhoMoznX0D7iQLN205qttIiIMg84IAy5G1yFNTzR32uaa0zvSf2_qHV24EAIhJ8974DyHkJec1Zzx9s2-hj2mWjCuaiZrxsUjsuONFJXgTfeY7FindNUZLc_IM8Q9Y8zIzjwlZ0IZ3ujG7MjdLYzglzh_owe3RJgXpCFl6iiCT_NAv0OpFyJN6-8Pn8aUy9uNdILFYTmAb-nFTHHFBaboaYb7CD-pK-kNqdzsxhUjPidPghsRXjzc5-Trxw9fLq-rm89Xny4vbirfqG6poOcDU8zoTpgASg3BaB1cEH0YOqf7EJz0g2-5GGTQRjLeN73rVaN10xnH5Tl5fep7yOnHEXCxU0QP4-hmSEe0vGlVywSTGypOqM8JMUOwhxwnl1fLmd0k273dJNtNsmXSFskl9Oqh_7GfYPgb-WO1AO9OAJQpi4ts0Re1Hoa4qbNDiv_v__6fuB_jHL0b72AF3KdjLkbLHBaFZfZ2W_O2Za4Yk23byV99o6Tm</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1564602031</pqid></control><display><type>article</type><title>Selecting patients for a second hepatectomy for colorectal metastases: An systemic review and meta-analysis</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Luo, L.X ; Yu, Z.Y ; Huang, J.W ; Wu, H</creator><creatorcontrib>Luo, L.X ; Yu, Z.Y ; Huang, J.W ; Wu, H</creatorcontrib><description>Abstract Background Opinions on the suitability of repeat hepatectomy for patients with recurrent colorectal liver metastases (CRLMs) vary among studies. We conducted a meta-analysis to establish the criteria for selecting the best candidates for a second hepatectomy. Methods Database and manual searches were performed to identify comparative or prognostic studies published up to October 2013. Outcomes of interest included disease characteristics, perioperative outcomes, and long-term survival after initial and second hepatectomies for patients with CRLM. Study quality was appraised using the Newcastle–Ottawa scale and a modified Hayden's score. Results A total of 7226 patients from 27 studies were included. Recurrent CRLMs after initial hepatectomy were more likely to be solitary (RR = 0.86, P = 0.045), unilobar (RR = 0.60, P < 0.001), and smaller (WMD = −0.66, P < 0.001). Postoperative morbidity and mortality were comparable between initial and second hepatectomies (RR = 1.10, P = 0.191; RR = 0.78, P = 0.678, respectively). In high-quality studies, patients showed better survival after a second hepatectomy than those after a single hepatectomy (HR = 0.68, P = 0.022). Patients meeting the following six predictors survived longer after second hepatectomy: disease-free survival after initial hepatectomy >1 y ( P = 0.034); solitary CRLM at second hepatectomy ( P < 0.001); unilobar CRLM at second hepatectomy ( P = 0.009); maximal size of CRLM at second hepatectomy ≤5 cm ( P = 0.035); lack of extrahepatic metastases at second hepatectomy ( P < 0.001); and R0 resection at second hepatectomy ( P < 0.001). Conclusions Second hepatectomy is a safe and feasible procedure for patients with recurrent CRLM. In fact, in well-selected patients it improves overall survival. The established criteria can help clinicians to select the best candidates for second hepatectomy and to achieve better long-term outcomes after resection.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2014.03.012</identifier><identifier>PMID: 24915859</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Carcinoma - secondary ; Carcinoma - surgery ; Colorectal cancer ; Colorectal Neoplasms - pathology ; Disease-Free Survival ; Female ; Hematology, Oncology and Palliative Medicine ; Hepatectomy - methods ; Humans ; Liver metastasis ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Male ; Metastasectomy - methods ; Middle Aged ; Neoplasm Recurrence, Local - secondary ; Neoplasm Recurrence, Local - surgery ; Patient Selection ; Reoperation - methods ; Repeat hepatectomy ; Surgery</subject><ispartof>European journal of surgical oncology, 2014-09, Vol.40 (9), p.1036-1048</ispartof><rights>Elsevier Ltd</rights><rights>2014 Elsevier Ltd</rights><rights>Copyright © 2014 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c547t-eb1d04098729fe44df988faf2bfd7a8bffa3cdc612d3f89301b5bab4588579a13</citedby><cites>FETCH-LOGICAL-c547t-eb1d04098729fe44df988faf2bfd7a8bffa3cdc612d3f89301b5bab4588579a13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0748798314003667$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24915859$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luo, L.X</creatorcontrib><creatorcontrib>Yu, Z.Y</creatorcontrib><creatorcontrib>Huang, J.W</creatorcontrib><creatorcontrib>Wu, H</creatorcontrib><title>Selecting patients for a second hepatectomy for colorectal metastases: An systemic review and meta-analysis</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Abstract Background Opinions on the suitability of repeat hepatectomy for patients with recurrent colorectal liver metastases (CRLMs) vary among studies. We conducted a meta-analysis to establish the criteria for selecting the best candidates for a second hepatectomy. Methods Database and manual searches were performed to identify comparative or prognostic studies published up to October 2013. Outcomes of interest included disease characteristics, perioperative outcomes, and long-term survival after initial and second hepatectomies for patients with CRLM. Study quality was appraised using the Newcastle–Ottawa scale and a modified Hayden's score. Results A total of 7226 patients from 27 studies were included. Recurrent CRLMs after initial hepatectomy were more likely to be solitary (RR = 0.86, P = 0.045), unilobar (RR = 0.60, P < 0.001), and smaller (WMD = −0.66, P < 0.001). Postoperative morbidity and mortality were comparable between initial and second hepatectomies (RR = 1.10, P = 0.191; RR = 0.78, P = 0.678, respectively). In high-quality studies, patients showed better survival after a second hepatectomy than those after a single hepatectomy (HR = 0.68, P = 0.022). Patients meeting the following six predictors survived longer after second hepatectomy: disease-free survival after initial hepatectomy >1 y ( P = 0.034); solitary CRLM at second hepatectomy ( P < 0.001); unilobar CRLM at second hepatectomy ( P = 0.009); maximal size of CRLM at second hepatectomy ≤5 cm ( P = 0.035); lack of extrahepatic metastases at second hepatectomy ( P < 0.001); and R0 resection at second hepatectomy ( P < 0.001). Conclusions Second hepatectomy is a safe and feasible procedure for patients with recurrent CRLM. In fact, in well-selected patients it improves overall survival. The established criteria can help clinicians to select the best candidates for second hepatectomy and to achieve better long-term outcomes after resection.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carcinoma - secondary</subject><subject>Carcinoma - surgery</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Hepatectomy - methods</subject><subject>Humans</subject><subject>Liver metastasis</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Metastasectomy - methods</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - secondary</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Patient Selection</subject><subject>Reoperation - methods</subject><subject>Repeat hepatectomy</subject><subject>Surgery</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2L1TAUhoMoznX0D7iQLN205qttIiIMg84IAy5G1yFNTzR32uaa0zvSf2_qHV24EAIhJ8974DyHkJec1Zzx9s2-hj2mWjCuaiZrxsUjsuONFJXgTfeY7FindNUZLc_IM8Q9Y8zIzjwlZ0IZ3ujG7MjdLYzglzh_owe3RJgXpCFl6iiCT_NAv0OpFyJN6-8Pn8aUy9uNdILFYTmAb-nFTHHFBaboaYb7CD-pK-kNqdzsxhUjPidPghsRXjzc5-Trxw9fLq-rm89Xny4vbirfqG6poOcDU8zoTpgASg3BaB1cEH0YOqf7EJz0g2-5GGTQRjLeN73rVaN10xnH5Tl5fep7yOnHEXCxU0QP4-hmSEe0vGlVywSTGypOqM8JMUOwhxwnl1fLmd0k273dJNtNsmXSFskl9Oqh_7GfYPgb-WO1AO9OAJQpi4ts0Re1Hoa4qbNDiv_v__6fuB_jHL0b72AF3KdjLkbLHBaFZfZ2W_O2Za4Yk23byV99o6Tm</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>Luo, L.X</creator><creator>Yu, Z.Y</creator><creator>Huang, J.W</creator><creator>Wu, H</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140901</creationdate><title>Selecting patients for a second hepatectomy for colorectal metastases: An systemic review and meta-analysis</title><author>Luo, L.X ; Yu, Z.Y ; Huang, J.W ; Wu, H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c547t-eb1d04098729fe44df988faf2bfd7a8bffa3cdc612d3f89301b5bab4588579a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carcinoma - secondary</topic><topic>Carcinoma - surgery</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Hepatectomy - methods</topic><topic>Humans</topic><topic>Liver metastasis</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Male</topic><topic>Metastasectomy - methods</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - secondary</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Patient Selection</topic><topic>Reoperation - methods</topic><topic>Repeat hepatectomy</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luo, L.X</creatorcontrib><creatorcontrib>Yu, Z.Y</creatorcontrib><creatorcontrib>Huang, J.W</creatorcontrib><creatorcontrib>Wu, H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luo, L.X</au><au>Yu, Z.Y</au><au>Huang, J.W</au><au>Wu, H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Selecting patients for a second hepatectomy for colorectal metastases: An systemic review and meta-analysis</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>40</volume><issue>9</issue><spage>1036</spage><epage>1048</epage><pages>1036-1048</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Abstract Background Opinions on the suitability of repeat hepatectomy for patients with recurrent colorectal liver metastases (CRLMs) vary among studies. We conducted a meta-analysis to establish the criteria for selecting the best candidates for a second hepatectomy. Methods Database and manual searches were performed to identify comparative or prognostic studies published up to October 2013. Outcomes of interest included disease characteristics, perioperative outcomes, and long-term survival after initial and second hepatectomies for patients with CRLM. Study quality was appraised using the Newcastle–Ottawa scale and a modified Hayden's score. Results A total of 7226 patients from 27 studies were included. Recurrent CRLMs after initial hepatectomy were more likely to be solitary (RR = 0.86, P = 0.045), unilobar (RR = 0.60, P < 0.001), and smaller (WMD = −0.66, P < 0.001). Postoperative morbidity and mortality were comparable between initial and second hepatectomies (RR = 1.10, P = 0.191; RR = 0.78, P = 0.678, respectively). In high-quality studies, patients showed better survival after a second hepatectomy than those after a single hepatectomy (HR = 0.68, P = 0.022). Patients meeting the following six predictors survived longer after second hepatectomy: disease-free survival after initial hepatectomy >1 y ( P = 0.034); solitary CRLM at second hepatectomy ( P < 0.001); unilobar CRLM at second hepatectomy ( P = 0.009); maximal size of CRLM at second hepatectomy ≤5 cm ( P = 0.035); lack of extrahepatic metastases at second hepatectomy ( P < 0.001); and R0 resection at second hepatectomy ( P < 0.001). Conclusions Second hepatectomy is a safe and feasible procedure for patients with recurrent CRLM. In fact, in well-selected patients it improves overall survival. The established criteria can help clinicians to select the best candidates for second hepatectomy and to achieve better long-term outcomes after resection.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>24915859</pmid><doi>10.1016/j.ejso.2014.03.012</doi><tpages>13</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Carcinoma - secondary Carcinoma - surgery Colorectal cancer Colorectal Neoplasms - pathology Disease-Free Survival Female Hematology, Oncology and Palliative Medicine Hepatectomy - methods Humans Liver metastasis Liver Neoplasms - secondary Liver Neoplasms - surgery Male Metastasectomy - methods Middle Aged Neoplasm Recurrence, Local - secondary Neoplasm Recurrence, Local - surgery Patient Selection Reoperation - methods Repeat hepatectomy Surgery |
| title | Selecting patients for a second hepatectomy for colorectal metastases: An systemic review and meta-analysis |
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