Different Surgical Strategies in Colorectal Cancer Patients With Synchronous Liver Metastasis: A Meta-Analysis.
Haitham M Azmy, Ali A Shafik, Ahmed Hussein Ahmed et al.
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In 30 seconds
This systematic review and meta-analysis compared colon-first, liver-first, and simultaneous resection strategies for patients with colorectal adenocarcinoma and synchronous liver metastases without extrahepatic disease. Overall survival at 1, 3, and 5 years did not differ significantly among the strategies. For simultaneous versus colon-first resection, reported survival was 90.1% vs 87.9% at 1 year, 66.5% vs 56.2% at 3 years, and 48% vs 40.7% at 5 years. The review found no clear survival advantage for any sequencing approach.
Key findings
- No statistically significant differences in 1-, 3-, or 5-year overall survival were found among the three surgical strategies.
- Simultaneous versus colon-first resection had 1-year survival of 90.1% vs 87.9%, 3-year survival of 66.5% vs 56.2%, and 5-year survival of 48% vs 40.7%.
- Colon-first and liver-first approaches also showed no significant differences in overall survival at 1, 3, or 5 years.
Why it matters
The findings suggest that surgical sequencing alone may not determine survival for patients with synchronous colorectal and liver disease. They support considering the clinical context—including patient characteristics, hepatic tumour burden, primary tumour features, and institutional expertise—rather than assuming one sequence is superior. The evidence also highlights the need for higher-quality randomized trials in this heterogeneous population.
What to keep in mind
The review calls for further high-quality randomized controlled trials, indicating that the available evidence does not establish an optimal strategy.