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Resection versus no intervention or other surgical interventions for colorectal cancer liver metastasesAl-asfoor A, Fedorowicz Z, Lodge M
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SummaryResection versus no intervention or other surgical interventions for colorectal cancer liver metastasesAbout one in four of patients with metastatic colorectal cancer have metastases isolated to the liver, of which 10 to 25% are eligible for ablation of the liver metastases. Preliminary data indicate that tumour ablation therapy can lead to improved survival in appropriately selected patients with hepatic metastases. Assessment of the long-term survival benefit of patients receiving ablative therapy and a comparison of its efficacy to that of liver resection is an important issue in the management of hepatic metastasis. This review compared surgical therapy with other non-surgical modalities, and only one trial involving 123 people was included. There was no evidence to support a single approach, either surgical or non-surgical for the management of colorectal liver metastases. Therefore, treatment decisions should continue to be based on individual circumstances and clinician's experience.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
July 18. 2007 AbstractBackgroundAbout one in four of patients with metastatic colorectal cancer have metastases isolated to the liver, of which 10% to 25% are eligible for ablation of the liver metastases, improving the five year survival rate. ObjectivesThe primary objectives were to compare resection of liver metastases to no intervention and other modalities of intervention (including cryosurgery and radiofrequency ablation) in terms of the benefits and harms for each intervention. Search strategySearches were conducted of the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases up to October 2006. In addition, references were scrutinized in identified eligible trials. Selection criteriaOnly randomized controlled trials reporting patients (regardless of age and sex) who had had curative surgery for adenocarcinoma of the colon or rectum, had been diagnosed with liver metastases and who were eligible for liver resection (i.e. with no evidence of primary or metastatic cancer elsewhere) were considered. Data collection and analysisTwo review authors independently extracted data using a form designed for this review. Discrepancies were resolved by consensus. Main resultsOnly one trial involving 123 people (87 male 36 female) was included. The data from this ten year prospective, randomized clinical trial suggest that hepatic cryosurgery is effective in the treatment of resectable and nonresectable liver metastases. The results show intra-operative tumor reduction (≥ 90% or ≤ 97%) and extended higher survival in these patients. The study indicated a five year and ten year survival rate of 44% and 19% after cryosurgery, respectively. However, it was not possible to separate out and unravel the outcomes data that related only to the participants (66.6%) with liver metastases from colorectal cancer as opposed to those with liver metastases from other primary tumors. Authors' conclusionsThere is currently insufficient evidence to support a single approach, either surgical or non-surgical, for the management of colorectal liver metastases. Therefore, treatment decisions should continue to be based on individual circumstances and clinician's experience. The authors conclude that local ablative therapies are probably useful, but that they need to be further evaluated in a randomized controlled trial. |