Pooled analysis of the surgical treatment for colorectal cancer liver metastases
A partir d'une revue systématique de la littérature publiée jusqu'en janvier 2013 (14 articles), cette étude analyse en termes de survie quelle est la meilleure séquence thérapeutique pour traiter des patients atteints d'un cancer colorectal avec métastases hépatiques synchrones ou métachrones résécables
The presence of liver metastases in a patient with colorectal cancer decreases the expected 5 year survival rates by a factor close to nine. It is generally accepted that resection of liver metastases should be attempted whenever feasible. This systematic review addresses the optimal therapeutic plan regarding timing of resection of synchronous liver metastases and the use of chemotherapy in combination with resection of synchronous metachronous liver metastases. The aim of the review is to pool all published results in order to attribute a level of evidence to outcomes and to identify areas where evidence is lacking. A systematic search of guidelines (9/2012), reviews (2/2009-1/2013), randomized controlled and observational studies (1/2010-1/2013) yielded 5 guidelines, 7 systematic reviews, 1 randomized controlled trial and 1 retrospective study. Data were extracted and analysed including updating a meta-analysis. The data failed to demonstrate an effect of timing of surgery or use of chemotherapy on overall survival. Concomitant resection of liver metastases and the primary tumour may result in lower postoperative morbidity. Systemic peri-operative chemotherapy may improve progression free survival compared to surgery alone.
http://www.sciencedirect.com/science/article/pii/S1040842814002121 2015