Surgical resection is the gold standard for treating synchronous colorectal liver metastases (CRLM). The resection of the primary tumor and metastatic lesions can follow different sequences: “simultaneous”, “bowel-first”, and “liver-first”. Conservative approaches, such as parenchymal-sparing surgery and segmentectomy, may serve as alternatives to major hepatectomy. A comprehensive search of Medline, Epistemonikos, Scopus, and the Cochrane Library was conducted. Studies evaluating patients who underwent surgery for CRLM and reported survival results were included. Other secondary outcomes were analyzed, including disease-free survival, perioperative complications and mortality, and recurrence rates. Quality assessment was performed using the AMSTAR-2 method. No significant differences in overall survival, disease-free survival, and secondary outcomes were observed when comparing simultaneous to “bowel-first” resections, despite a higher rate of perioperative mortality in the former group. The 5-year OS was significantly higher for simultaneous resection compared to “liver-first” resection. No significant differences in OS and DFS were noted when comparing “liver-first” to “bowel-first” resection, or anatomic to non-anatomic resection. Our umbrella review validates simultaneous surgery as an effective oncological approach for treating SCRLM, though the increased risk of perioperative morbidity highlights the importance of selecting suitable patients. Non-anatomic resections might be favored to preserve liver function and enable future surgical interventions.
手术切除是治疗同时性结直肠肝转移（CRLM）的金标准。原发性肿瘤与转移灶的切除可采用不同顺序："同期切除"、"肠道优先"和"肝脏优先"。保留实质的肝切除术及肝段切除术等保守术式可作为大范围肝切除的替代方案。本研究系统检索了Medline、Epistemonikos、Scopus和Cochrane图书馆数据库，纳入评估CRLM手术患者并报告生存结局的研究，同时分析无病生存期、围手术期并发症与死亡率、复发率等次要结局。采用AMSTAR-2方法进行质量评估。结果显示：尽管同期切除组围手术期死亡率较高，但与"肠道优先"切除相比，两者在总生存期、无病生存期及次要结局方面均无显著差异；同期切除的5年总生存期显著高于"肝脏优先"切除；"肝脏优先"与"肠道优先"切除、解剖性与非解剖性切除在总生存期和无病生存期方面均无显著差异。本伞状综述证实同期手术是治疗同时性结直肠肝转移的有效肿瘤学策略，但围手术期并发症风险的增加凸显了患者选择的重要性。非解剖性切除术因能保留肝功能并为后续手术干预创造条件，可能更具临床优势。
Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review
肿瘤(癌症)患者之家