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No evidence from randomised clinical trials for optimal management of patients with large bowel cancer spread to lymph glands draining the liver

Nearly a third of patients with large bowel cancers (colorectal cancer) spread to the liver (liver metastases) within five years of diagnosis of bowel cancer. The affected part of the liver can be removed surgically in a quarter of such patients who develop liver spread from bowel cancer. About a seventh of these patients, in whom the affected part of the liver is suitable for removal, develop cancer involvement of lymph glands draining the liver (hepatic lymph node). Such patients are associated with poor survival even after removal of the affected part of the liver and the involved nodes. This Cochrane review attempted to answer the question of whether removing the part of the liver is better than other forms of treatment (such as no treatment, chemotherapy, heat destructive therapy using radiofrequency waves, ie, radiofrequency ablation) in such patients but did not find any randomised clinical trial addressing the issue. Currently, there is no evidence from randomised clinical trials for optimal management of these patients. High quality randomised clinical trials are feasible and are necessary to determine the optimal management of patients with colorectal liver metastases with hepatic node involvement.

Latar Belakang

Involvement of hepatic lymph node in patients with colorectal liver metastases is associated with poor prognosis.

Matlamat

To determine the benefits and harms of curative liver resection with lymphadenectomy versus other treatments for colorectal liver metastases with hepatic node involvement.

Kaedah Pencarian

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and LILACS until September 2009 for identifying the randomised trials.

Kriteria Pemilihan

We considered only randomised clinical trials (irrespective of language, blinding, or publication status) comparing liver resection (alone or in combination with radiofrequency ablation or cryoablation) versus other treatments (neo-adjuvant chemotherapy, chemotherapy, or radiofrequency ablation) in patients with colorectal liver metastases with hepatic node involvement.

Pengumpulan Data dan Analisis

Two authors independently identified trials for inclusion.

Keputusan Utama

We were unable to identify any randomised clinical trial fulfilling the inclusion criteria of this review. We were also unable to identify any quasi-randomised or cohort studies, which could meaningfully answer this important issue.

Kesimpulan Pengarang

There is no evidence in the literature to assess the role of surgery versus other treatments for patients with colorectal liver metastases with hepatic node involvement. High quality randomised clinical trials are feasible and are necessary to determine the optimal management of patients with colorectal liver metastases with hepatic node involvement.

Petikan
Gurusamy KS, Ramamoorthy R, Imber C, Davidson BR. Surgical resection versus non-surgical treatment for hepatic node positive patients with colorectal liver metastases. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD006797. DOI: 10.1002/14651858.CD006797.pub2.

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