The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol
Abstract Introduction Liver resection (LR) in patients with liver metastasis from colorectal cancer remains the only curative treatment. Perioperative chemotherapy improves prognosis of these patients. However, there are concerns regarding the effect of preoperative chemotherapy on liver regeneratio...
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | Systematic Reviews |
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| Online Access: | https://doi.org/10.1186/s13643-020-01545-w |
| _version_ | 1819072644915396608 |
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| author | Mihai-Calin Pavel Raquel Casanova Laia Estalella Robert Memba Erik Llàcer-Millán Mar Achalandabaso Elisabet Julià Justin Geoghegan Rosa Jorba |
| author_facet | Mihai-Calin Pavel Raquel Casanova Laia Estalella Robert Memba Erik Llàcer-Millán Mar Achalandabaso Elisabet Julià Justin Geoghegan Rosa Jorba |
| author_sort | Mihai-Calin Pavel |
| collection | DOAJ |
| description | Abstract Introduction Liver resection (LR) in patients with liver metastasis from colorectal cancer remains the only curative treatment. Perioperative chemotherapy improves prognosis of these patients. However, there are concerns regarding the effect of preoperative chemotherapy on liver regeneration, which is a key event in avoiding liver failure after LR. The primary objective of this systematic review is to assess the effect of neoadjuvant chemotherapy on liver regeneration after (LR) or portal vein embolization (PVE) in patients with liver metastasis from colorectal cancer. The secondary objectives are to evaluate the impact of the type of chemotherapy, number of cycles, and time between end of treatment and procedure (LR or PVE) and to investigate whether there is an association between degree of hypertrophy and postoperative liver failure. Methods This meta-analysis will include studies reporting liver regeneration rates in patients submitted to LR or PVE. Pubmed, Scopus, Web of Science, Embase, and Cochrane databases will be searched. Only studies comparing neoadjuvant vs no chemotherapy, or comparing chemotherapy characteristics (bevacizumab administration, number of cycles, and time from finishing chemotherapy until intervention), will be included. We will select studies from 1990 to present. Two researchers will individually screen the identified records, according to a list of inclusion and exclusion criteria. Primary outcome will be future liver remnant regeneration rate. Bias of the studies will be evaluated with the ROBINS-I tool, and quality of evidence for all outcomes will be determined with the GRADE system. The data will be registered in a predesigned database. If selected studies are sufficiently homogeneous, we will perform a meta-analysis of reported results. In the event of a substantial heterogeneity, a qualitative systematic review will be performed. Discussion The results of this systematic review may help to better identify the patients affected by liver metastasis that could present low regeneration rates after neoadjuvant chemotherapy. These patients are at risk to develop liver failure after extended hepatectomies and therefore are not good candidates for such aggressive procedures. Systematic review registration PROSPERO registration number: CRD42020178481 (July 5, 2020). |
| first_indexed | 2024-12-21T17:41:01Z |
| format | Article |
| id | doaj.art-242b9febf021447398aea55266d213a1 |
| institution | Directory Open Access Journal |
| issn | 2046-4053 |
| language | English |
| last_indexed | 2024-12-21T17:41:01Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
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| series | Systematic Reviews |
| spelling | doaj.art-242b9febf021447398aea55266d213a12022-12-21T18:55:37ZengBMCSystematic Reviews2046-40532020-12-019111110.1186/s13643-020-01545-wThe effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocolMihai-Calin Pavel0Raquel Casanova1Laia Estalella2Robert Memba3Erik Llàcer-Millán4Mar Achalandabaso5Elisabet Julià6Justin Geoghegan7Rosa Jorba8HPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIIIHPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIIIHPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIIIHPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIIIHPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIIIHPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIIIHPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIIIHPB and Liver Transplant Surgery Department, St. Vincent’s University HospitalHPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIIIAbstract Introduction Liver resection (LR) in patients with liver metastasis from colorectal cancer remains the only curative treatment. Perioperative chemotherapy improves prognosis of these patients. However, there are concerns regarding the effect of preoperative chemotherapy on liver regeneration, which is a key event in avoiding liver failure after LR. The primary objective of this systematic review is to assess the effect of neoadjuvant chemotherapy on liver regeneration after (LR) or portal vein embolization (PVE) in patients with liver metastasis from colorectal cancer. The secondary objectives are to evaluate the impact of the type of chemotherapy, number of cycles, and time between end of treatment and procedure (LR or PVE) and to investigate whether there is an association between degree of hypertrophy and postoperative liver failure. Methods This meta-analysis will include studies reporting liver regeneration rates in patients submitted to LR or PVE. Pubmed, Scopus, Web of Science, Embase, and Cochrane databases will be searched. Only studies comparing neoadjuvant vs no chemotherapy, or comparing chemotherapy characteristics (bevacizumab administration, number of cycles, and time from finishing chemotherapy until intervention), will be included. We will select studies from 1990 to present. Two researchers will individually screen the identified records, according to a list of inclusion and exclusion criteria. Primary outcome will be future liver remnant regeneration rate. Bias of the studies will be evaluated with the ROBINS-I tool, and quality of evidence for all outcomes will be determined with the GRADE system. The data will be registered in a predesigned database. If selected studies are sufficiently homogeneous, we will perform a meta-analysis of reported results. In the event of a substantial heterogeneity, a qualitative systematic review will be performed. Discussion The results of this systematic review may help to better identify the patients affected by liver metastasis that could present low regeneration rates after neoadjuvant chemotherapy. These patients are at risk to develop liver failure after extended hepatectomies and therefore are not good candidates for such aggressive procedures. Systematic review registration PROSPERO registration number: CRD42020178481 (July 5, 2020).https://doi.org/10.1186/s13643-020-01545-wLiver regenerationLiver resectionPortal vein embolizationColorectal cancer liver metastasisNeoadjuvant chemotherapySystematic review |
| spellingShingle | Mihai-Calin Pavel Raquel Casanova Laia Estalella Robert Memba Erik Llàcer-Millán Mar Achalandabaso Elisabet Julià Justin Geoghegan Rosa Jorba The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol Systematic Reviews Liver regeneration Liver resection Portal vein embolization Colorectal cancer liver metastasis Neoadjuvant chemotherapy Systematic review |
| title | The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol |
| title_full | The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol |
| title_fullStr | The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol |
| title_full_unstemmed | The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol |
| title_short | The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol |
| title_sort | effect of preoperative chemotherapy on liver regeneration after portal vein embolization ligation or liver resection in patients with colorectal liver metastasis a systematic review protocol |
| topic | Liver regeneration Liver resection Portal vein embolization Colorectal cancer liver metastasis Neoadjuvant chemotherapy Systematic review |
| url | https://doi.org/10.1186/s13643-020-01545-w |
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