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


OBJECTIVE
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.


METHODS
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.


METHODS
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.


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


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.


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 clinician's experience. The authors conclude that local ablative therapies are probably useful, but that they need to be further evaluated in a randomized controlled trial.
Al-Asfoor
A
A
Fedorowicz
Z
Z
Lodge
M
M
D015179:Colorectal Neoplasms; D003452:Cryosurgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D016032:Randomized Controlled Trials as Topic