PDF(Pubmed)
Abstract：
Surgical resection is the gold standard for treating synchronous colorectal liver metastases (CRLM). The resection of the primary tumor and metastatic lesions can follow different sequences: \"simultaneous\", \"bowel-first\", and \"liver-first\". Conservative approaches, such as parenchymal-sparing surgery and segmentectomy, may serve as alternatives to major hepatectomy. A comprehensive search of Medline, Epistemonikos, Scopus, and the Cochrane Library was conducted. Studies evaluating patients who underwent surgery for CRLM and reported survival results were included. Other secondary outcomes were analyzed, including disease-free survival, perioperative complications and mortality, and recurrence rates. Quality assessment was performed using the AMSTAR-2 method. No significant differences in overall survival, disease-free survival, and secondary outcomes were observed when comparing simultaneous to \"bowel-first\" resections, despite a higher rate of perioperative mortality in the former group. The 5-year OS was significantly higher for simultaneous resection compared to \"liver-first\" resection. No significant differences in OS and DFS were noted when comparing \"liver-first\" to \"bowel-first\" resection, or anatomic to non-anatomic resection. Our umbrella review validates simultaneous surgery as an effective oncological approach for treating SCRLM, though the increased risk of perioperative morbidity highlights the importance of selecting suitable patients. Non-anatomic resections might be favored to preserve liver function and enable future surgical interventions.
摘要：
手术切除是治疗同步结直肠肝转移（CRLM）的金标准。原发肿瘤和转移性病变的切除可以遵循不同的顺序：“同时”，\"肠先\"，和“肝脏优先”。保守的方法，如保留实质手术和节段切除术，可以作为主要肝切除术的替代方案。全面搜索Medline,认识论，Scopus,并进行了Cochrane图书馆。包括评估接受CRLM手术并报告生存结果的患者的研究。分析了其他次要结果，包括无病生存，围手术期并发症和死亡率，和复发率。使用AMSTAR-2方法进行质量评估。总生存率无显著差异，无病生存,和次要结局在同时与“肠-先”切除比较时观察到，尽管前一组的围手术期死亡率较高。与“肝脏优先”切除相比，同时切除的5年OS明显更高。比较“肝脏优先”和“肠道优先”切除时，OS和DFS没有显着差异，或解剖到非解剖切除。我们的综述验证了同时手术是治疗SCRLM的有效肿瘤方法，尽管围手术期发病率增加的风险凸显了选择合适患者的重要性。非解剖切除可能有利于保持肝功能，并使未来的手术干预。
