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A meta-analysis of liver-first versus classical strategy for synchronous colorectal liver metastases

Abstract

Background

This study aimed to compare the perioperative outcomes of liver-first (LFS) and classical (CS) strategy for the management of synchronous colorectal liver metastases (sCRLM).

Method

A literature search was performed in PubMed, Scopus, and Cochrane databases, in accordance with the PRISMA guidelines. The odds ratio, weighted mean difference, and 95% confidence interval were evaluated by means of the random-effects model.

Results

Ten articles met the inclusion criteria, incorporating 3656 patients. Patients in the LFS group reported increased size of sCRLM and a higher rate of major hepatectomies. This study reveals comparable overall survival and disease-free survival at 1, 3, and 5 years postoperatively between the two strategies. Moreover, the mean operative time, length of hospital stay, the incidence of severe complications, and the 30-day and 90-day mortality were similar between the two groups. The mean intraoperative blood loss was significantly increased in the LFS group.

Conclusion

These outcomes suggest that both approaches are feasible and safe. Given the lack of randomized clinical trials, this meta-analysis represents the best currently available evidence. However, the results should be treated with caution given the small number of the included studies. Randomized trials comparing LFS to CS are necessary to further evaluate their outcomes.

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Author information

DEM contributed to the conception or design of the work; the acquisition, analysis, and interpretation of data for the work; the drafting the work and revising it critically for important intellectual content; and the final approval of the version to be published and is accountable for all aspects of the work.

GT contributed to the conception or design of the work, the interpretation of data for the work, the revising of the work critically for important intellectual content, and the final approval of the version to be published and is accountable for all aspects of the work.

AD contributed to the acquisition and analysis of data for the work, the drafting the work and revising it critically for important intellectual content, and the final approval of the version to be published and is accountable for all aspects of the work.

VST contributed to the conception or design of the work, the acquisition and analysis of data for the work, the drafting the work and revising it critically for important intellectual content, and the final approval of the version to be published and is accountable for all aspects of the work.

DZ contributed to the conception or design of the work, the interpretation of data for the work, the revising of the work critically for important intellectual content, and the final approval of the version to be published and is accountable for all aspects of the work.

Correspondence to Dimitris Zacharoulis.

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Magouliotis, D.E., Tzovaras, G., Diamantis, A. et al. A meta-analysis of liver-first versus classical strategy for synchronous colorectal liver metastases. Int J Colorectal Dis 35, 537–546 (2020). https://doi.org/10.1007/s00384-020-03503-3

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Keywords

  • Liver-first strategy
  • Classical strategy
  • Colorectal liver metastases
  • Meta-analysis