Meta‐analysis of outcomes following resection of the primary tumour in patients presenting with metastatic colorectal cancer. Issue 7 (31st October 2017)

• Record Type: Journal Article
• Authors: Nitsche, U.; Stöß, C.; Stecher, L.; Wilhelm, D.; Friess, H.; Ceyhan, G. O.
• Is Part Of: British journal of surgery. Volume 105:Issue 7(2018)
• Page Start: 784
• Page End: 796
• Publication Date: 2017-10-31
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.10682
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract : Background: It is not clear whether resection of the primary tumour (when there are metastases) alters survival and/or whether resection is associated with increased morbidity. This systematic review and meta‐analysis assessed the prognostic value of primary tumour resection in patients presenting with metastatic colorectal cancer. Methods: A systematic review of MEDLINE/PubMed was performed on 12 March 2016, with no language or date restrictions, for studies comparing primary tumour resection versus conservative treatment without primary tumour resection for metastatic colorectal cancer. The quality of the studies was assessed using the MINORS and STROBE criteria. Differences in survival, morbidity and mortality between groups were estimated using random‐effects meta‐analysis. Results: Of 37 412 initially screened articles, 56 retrospective studies with 148 151 patients met the inclusion criteria. Primary tumour resection led to an improvement in overall survival of 7·76 (95 per cent c.i. 5·96 to 9·56) months (risk ratio (RR) for overall survival 0·50, 95 per cent c.i. 0·47 to 0·53), but did not significantly reduce the risk of obstruction (RR 0·50, 95 per cent c.i. 0·16 to 1·53) or bleeding (RR 1·19, 0·48 to 2·97). Neither was the morbidity risk altered (RR 1·14, 0·77 to 1·68). Heterogeneity between the studies was high, with a calculated I 2 of more than 50 per cent for most outcomes. Conclusion: Primary tumour resection may provide a modest survival advantage in patients presenting with metastatic colorectal cancer. Abstract : Selected patients only