cochrane evidence in liver metastases treatment

7/29/2019 Cochrane Evidence in Liver Metastases Treatment

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Resection versus no intervention or other surgical

interventions for colorectal cancer liver metastases (Review)

Al-asfoor A, Fedorowicz Z, Lodge M

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library2008, Issue 4

http://www.thecochranelibrary.com

Resection versus no intervention or other surgical interventions for colorectal cancer liver metastases (Review)

Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
http://www.thecochranelibrary.com/http://www.thecochranelibrary.com/


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[Intervention Review]

Resection versus no intervention or other surgicalinterventions for colorectal cancer liver metastases

Ahmed Al-asfoor2, Zbys Fedorowicz1, Mark Lodge3

1UKCC (Bahrain Branch), Ministry of Health, Bahrain, Awali, Bahrain. 2Plastic and Reconstruction Unit, Departement of Surgery,

Manama, Bahrain. 3Cochrane Cancer Network, Oxford, UK

Contact address: Zbys Fedorowicz, UKCC (Bahrain Branch), Ministry of Health, Bahrain, Box 25438, Awali, Bahrain.

[email protected] .

Editorial group: Cochrane Colorectal Cancer Group.

Publication status and date: Edited (no change to conclusions), published in Issue 4, 2008.

Review content assessed as up-to-date: 3 February 2008.

Citation: Al-asfoorA, Fedorowicz Z, Lodge M. Resection versus no intervention or othersurgical interventionsfor colorectal cancer liver

metastases. Cochrane Database of Systematic Reviews2008, Issue 2. Art. No.: CD006039. DOI: 10.1002/14651858.CD006039.pub4.


A B S T R A C T

Background

About one in four of patients with metastatic colorectal cancer have metastases isolated to the l iver, of which 10% to 25% are eligible

for ablation of the liver metastases, improving the five year survival rate.

Treatments include hepatic resection and other modalities using cryosurgery and radiofrequency thermal ablation. Although new

modalities allow safe ablation of liver metastases without the need for surgical intervention, there are still no clear guidelines on the

appropriate management of patients with colorectal cancer and hepatic metastases.

Objectives

The 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 strategy

Searches 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 criteria

Only 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 analysis

Two review authors independently extracted data using a form designed for this review. Discrepancies were resolved by consensus.


mailto:[email protected]:[email protected]


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Main results

Only 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 conclusions

There 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 clinicians experience. The

authors conclude that local ablative therapies are probably useful, but that they need to be further evaluated in a randomized controlled

trial.

P L A I N L A N G U A G E S U M M A R Y

Resection versus no intervention or other surgical interventions for colorectal cancer liver metastases

About 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 clinicians experience.



cochrane evidence in liver metastases treatment

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