Clinical outcomes of curative treatment for colorectal liver metastases combined with cytoreductive surgery and intraperitoneal chemotherapy for peritoneal metastases: a systematic review and meta-analysis of current evidence,International Journal of Hyperthermia

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Clinical outcomes of curative treatment for colorectal liver metastases combined with cytoreductive surgery and intraperitoneal chemotherapy for peritoneal metastases: a systematic review and meta-analysis of current evidence
International Journal of Hyperthermia ( IF 3.0 ) Pub Date : 2020-08-12 , DOI: 10.1080/02656736.2020.1803424
Yifeng Zou _{1,

2} , Xi Chen _{1,

2} , Xinzhi Zhang _{1,

2} , Zhihong Shen ₃ , Jiawei Cai _{1,

2} , Yingxin Tan _{1,

2} , JingRong Weng _{1,

2} , Yuming Rong ₄ , Xutao Lin _{2,

5}

Affiliation

Abstract

Background

The optimal treatment for colorectal cancer (CRC) with synchronous peritoneal carcinomatosis (PC) and liver metastases (LM) remains controversial. We aimed to investigate clinical outcomes in patients with CRC and concomitant PC and LM who had undergone curative surgery, including resections at both metastatic sites and synchronous intraabdominal chemotherapy.

Methods

We searched PubMed, EMBASE, and Web of Science databases for eligible studies. Studies focusing on the clinical effects of curative surgery and synchronous intraabdominal chemotherapy for patients with CRC and concomitant PC and LM were included. Meta-analysis results were recorded as hazard ratios (HRs), risk ratios (RRs) and mean differences.

Results

We included 9 of 998 identified studies in the meta-analysis, involving 746 patients (221 patients with PC + LM, 525 patients with PC). Overall survival (pooled HR 1.68, 95% confidence interval [CI] 1.33–2.13, p < 0.01) and disease-free survival (pooled HR 1.82, 95% CI 1.51–2.20, p < 0.01) were both lower in patients with PC + LM. A higher recurrence rate (RR 1.22, 95% CI 1.04–1.44, p = 0.02) and major postoperative morbidity (RR 1.47, 95% CI 1.19–1.82, p < 0.01) were also observed in patients with PC + LM.

Conclusion

Liver resection in combination with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for patients with CRC and synchronous hepatic and peritoneal metastases may be associated with worse survival and higher morbidity compared with patients with isolated PC. More restricted patient inclusion criteria should be established to facilitate an optimal prognosis for this patient group.

中文翻译：

结直肠癌肝转移根治术联合细胞减灭术和腹膜内化疗治疗腹膜转移瘤的临床结果：系统评价和当前证据的荟萃分析

摘要

背景

大肠癌（CRC）并发腹膜癌（PC）和肝转移瘤（LM）的最佳治疗方法仍存在争议。我们的目的是调查接受根治性手术的CRC以及伴随PC和LM的患者的临床结局，包括在转移部位切除和同步腹腔内化疗。

方法

我们在PubMed，EMBASE和Web of Science数据库中搜索了符合条件的研究。纳入了针对CRC以及伴随PC和LM的患者进行的根治性手术和同步腹腔内化疗的临床效果的研究。荟萃分析结果记录为危险比（HRs），风险比（RRs）和平均差异。

结果

在荟萃分析中，我们纳入了998项经鉴定的研究中的9项，涉及746例患者（221例PC + LM患者，525例PC患者）。 PC患者的总生存率（合并HR 1.68，95 ％置信区间[CI] 1.33–2.13，p <0.01）和无病生存期（合并HR 1.82，95％CI 1.51-2.20，p <0.01）均较低+ LM。 PC + LM患者也观察到较高的复发率（RR 1.22，95％CI 1.04–1.44，p = 0.02）和严重的术后发病率（RR 1.47，95％CI 1.19–1.82，p <0.01）。