title: Systematic review and meta-analysis of follow-up after hepatectomy for colorectal liver metastases.
abstract: BACKGROUND
  The evidence surrounding optimal follow-up after liver resection for colorectal metastases remains unclear. A significant proportion of recurrences occur in the early postoperative period, and some groups advocate more intensive review at this time.
  
  
  METHODS
  A systematic review of literature published between January 2003 and May 2010 was performed. Studies that described potentially curative primary resection of colorectal liver metastases that involved a defined follow-up protocol and long-term survival data were included. For meta-analysis, studies were grouped into intensive (more frequent review in the first 5 years after resection) and uniform (same throughout) follow-up.
  
  
  RESULTS
  Thirty-five studies were identified that met the inclusion criteria, involving 7330 patients. Only five specifically addressed follow-up. Patients undergoing intensive early follow-up had a median survival of 39·8 (95 per cent confidence interval 34·3 to 45·3) months with a 5-year overall survival rate of 41·9 (34·4 to 49·4) per cent. Patients undergoing routine follow-up had a median survival of 40·2 (33·4 to 47·0) months, with a 5-year overall survival rate of 38·4 (32·6 to 44·3) months.
  
  
  CONCLUSIONS
  Evidence regarding follow-up after liver resection is poor. Meta-analysis failed to identify a survival advantage for intensive early follow-up.
authors.affiliation: Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, Liverpool, UK. robjones@liv.ac.uk
authors.forename: R P
authors.initials: RP
authors.lastname: Jones
authors.forename: R
authors.initials: R
authors.lastname: Jackson
authors.forename: D F J
authors.initials: DF
authors.lastname: Dunne
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: S W
authors.initials: SW
authors.lastname: Fenwick
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
authors.forename: P
authors.initials: P
authors.lastname: Ghaneh
mesh_terms: D015179:Colorectal Neoplasms; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011182:Postoperative Care / Q000379:methods