The role of liver resection for colorectal cancer metastases in an era of multimodality treatment: A systematic review

Quan, Douglas; Gallinger, Steven; Nhan, Cindy; Auer, Rebecca A.; Biagi, James J.; Fletcher, Glenn G.; Law, Calvin H.L.; Moulton, Carol-Anne E.; Ruo, Leyo; Wei, Alice C.; McLeod, Robin S.; Surgical Oncology Program at Cancer Care Ontario,

doi:10.1016/j.surg.2011.12.018

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The role of liver resection for colorectal cancer metastases in an era of multimodality treatment: A systematic review

Douglas Quan, MD, MSc
- London Health Sciences, University of Western Ontario, London, Ontario, Canada
Steven Gallinger, MD, Msc
- University Health Network, University of Toronto, Toronto, Ontario, Canada
Cindy Nhan, BScH
- Cancer Care Ontario, Toronto, Ontario, Canada
Rebecca A. Auer, MD, MSc
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
James J. Biagi, MD
- Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
Glenn G. Fletcher, MSc
- Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada
Calvin H.L. Law, MD, MPH
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Carol-Anne E. Moulton, MD, PhD
- University Health Network, University of Toronto, Toronto, Ontario, Canada
Leyo Ruo, MD
- McMaster University Medical Centre, McMaster University, Hamilton, Ontario, Canada
Alice C. Wei, MD, MSc
- University Health Network, University of Toronto, Toronto, Ontario, Canada
Robin S. McLeod, MD
- Cancer Care Ontario, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Reprint requests: Robin S. McLeod, MD, Mount Sinai Hospital, 451-600 University Avenue, Toronto, ON M5G 1X5, Canada.
Surgical Oncology Program at Cancer Care Ontario

Accepted 22 December 2011. published online 10 February 2012.
Corrected Proof

Background

To determine the role of liver resection in patients with liver and extrahepatic colorectal cancer metastases and the role of chemotherapy in patients in conjunction with liver resection.

Methods

MEDLINE and EMBASE databases were searched for articles published between 1995 and 2010, along with hand searching.

Results

A total of 4875 articles were identified, and 83 were retained for inclusion. Meta-analysis was not performed because of heterogeneity and poor quality of the evidence. Outcomes in patients who had liver and lung metastases, liver and portal node metastases, and liver and other extrahepatic disease were reported in 14, 10, and 14 studies, respectively. The role of perioperative chemotherapy was assessed in 30 studies, including 1 randomized controlled trial and 1 pooled analysis. Ten studies assessed the role of chemotherapy in patients with initially unresectable disease, and 5 studies assessed the need for operation after a radiologic complete response.

Conclusion

The review suggests that: (1) select patients with pulmonary and hepatic CRC metastases may benefit from resection; (2) perioperative chemotherapy may improve outcome in patients undergoing a liver resection; (3) patients whose CRC liver metastases are initially unresectable may benefit from chemotherapy to identify a subgroup who may benefit later from resection; (4) after radiographic complete response (RCR), lesions should be resected if possible.