Systematic review and meta-analysis of follow-up after hepatectomy for colorectal liver metastases

• Published in: British journal of surgery Vol. 99; no. 4; pp. 477 - 486
• Main Authors: Jones, R. P., Jackson, R., Dunne, D. F. J., Malik, H. Z., Fenwick, S. W., Poston, G. J., Ghaneh, P.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.04.2012; Wiley
• Subjects: Biological and medical sciences; Colorectal Neoplasms; Disease-Free Survival; Follow-Up Studies; General aspects; Hepatectomy - mortality; Hepatectomy - statistics & numerical data; Humans; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Miscellaneous; Neoplasm Recurrence, Local - mortality; Postoperative Care - methods; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Rectal disease; Statistical analysis; Evidence-based practice; Colorectal cancer; Hepatic disease; Systematic review; Malignant tumor; Evidence-based medicine; Metaanalysis; Hepatectomy; Colonic disease; Treatment; Follow up study; Surgery; Digestive diseases; Intestinal disease; Liver metastasis; Bibliographic review; Cancer
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.8667

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. Conclusion: Evidence regarding follow‐up after liver resection is poor. Meta‐analysis failed to identify a survival advantage for intensive early follow‐up. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. No advantage for intense early follow‐up