Evaluation Efficacy And Safety Of Synchronous Colorectal Liver Metastases Undergoing Simultaneous Or Staged Operation: A Mata Analysis

Objective: To compare the safety and clinical efficacy of simultaneous resection versus staged resection for synchronous colorectal liver metastases using Meta-analysis method.Methods:Nonrandomized controlled study(NRCT) comparing safety and clinical efficacy of simultaneous resection versus staged resection for synchronous colorectal liver metastases published from March 2004 to March 2014. A Meta-analysis was conducted to estimate average operation time, intraoperative blood transfusion volume, average hospitalization time, intraoperative blood loss, perioperative mortality associated with surgery, total complications, infection of incision, bile leakage, liver weeks or phrenic abscess, hepatic insufficiency, anastomotic leakage, pulmonary infection, pleural effusion, heart disease and other complications, the total average survival time after operation, 1 year overall survival rate, 3 year overall survival rate, 5 year overall survival rate, average disease-free survival time after operation, 1 year disease-free survival rate, 3 year disease-free survival rate, postoperative 5-year disease-free survival rate.Results:1.Literature screening results: A total of 16 NRCT were included in this analysis.2.The safety of simultaneous resection versus staged resection: the average operation time difference was not statistically significant(WMD=-49.81, 95%CI:-125.07~ 25.46,P=0.19), the intraoperative blood transfusion volume difference was not statistically significant(WMD=-226.15, 95%CI:-509.85~ 57.55, P=0.12), intraoperative blood loss difference was not statistically significant(WMD=-94.76, 95%CI:-255.63~ 66.12, P=0.25), the average hospitalization time was higher in simultaneous resection and the difference was statistically significant(WMD=-6.30, 95%CI:-8.30~-4.31, P <0.00001), the mortality associated with surgery difference was not statistically significant(OR=1.69, 95%CI: 0.82~ 3.52, P=0.16).3.The complications in simultaneous resection versus staged resection: the difference of total complications rate was not statistically significant(OR=1.26, 95%CI: 0.84~ 1.88, P=0.26), the difference of infection of incision was not statistically significant(OR=1.17, 95%CI: 0.69~ 1.98, P=0.56), the difference of bile leakage was not statistically significant(OR=0.68, 95%CI: 0.39~ 1.20, P=0.19), the difference of liver weeks or phrenic abscess was not statistically significant(OR=1.36, 95%CI: 0.74~ 2.50, P=0.32), the difference of hepatic insufficiency was not statistically significant(OR=0.89, 95%CI: 0.46~ 1.69, P=0.71), the difference of anastomotic leakage was not statistically significant(OR=1.15, 95%CI: 0.47~ 2.82, P=0.77), the difference of pulmonary infection was not statistically significant(OR=0.77, 95%CI: 0.47~ 1.27, P=0.31), the difference of pleural effusion was not statistically significant(OR=1.23, 95%CI: 0.69~ 2.20, P=0.49), the difference of heart disease was not statistically significant(OR=1.18, 95%CI: 0.63~ 2.19, P=0.60).4. The clinical efficacy in simultaneous resection versus staged resection: the difference of 1 year overall survival rate was not statistically significant(OR=0.69, 95%CI: 0.46~ 1.04, P=0.08), the difference of 3 year overall survival rate was not statistically significant(OR=1.05, 95%CI: 0.81~ 1.37, P=0.69), the difference of 5 year overall survival rate was not statistically significant(OR=1.00, 95%CI: 0.74~ 1.36, P=0.98), the difference of 1 year disease-free survival rate was not statistically significant(OR=0.50, 95%CI: 0.15~ 1.63, P=0.25), the difference of 3 year disease-free survival rate was not statistically significant(OR=0.74, 95%CI: 0.39~ 1.39, P=0.34), the difference of 5 year disease-free survival rate was not statistically significant(OR=1.52, 95%CI: 0.57~ 4.03, P=0.40).Conclusion:1.The average hospitalization time was higher in simultaneous resection while other safety index are not statistically significant.2.The rate of complications in simultaneous resection and staged resection are not statistically significant.3.The clinical efficacy in simultaneous resection and staged resection are not statistically significant.4. The choice of operation plan for synchronous colorectal liver metastases must be taken into account with the comprehensive judgement of the patient’s general condition, the condition of primary tumor, the position and number of the liver metastases.