Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review
The liver is the most common site of colorectal cancer metastatic spread. Although metastasectomy is the gold standard for fit patients with resectable colorectal cancer liver metastases (CRLMs), their management after surgical treatment remains controversial. The objective of this systematic review...
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| Format: | Article |
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MDPI AG
2023-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/6/2401 |
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| author | Emmanouil Georgilis Maria Gavriatopoulou Diamantis I. Tsilimigras Panagiotis Malandrakis Theodosios Theodosopoulos Ioannis Ntanasis-Stathopoulos |
| author_facet | Emmanouil Georgilis Maria Gavriatopoulou Diamantis I. Tsilimigras Panagiotis Malandrakis Theodosios Theodosopoulos Ioannis Ntanasis-Stathopoulos |
| author_sort | Emmanouil Georgilis |
| collection | DOAJ |
| description | The liver is the most common site of colorectal cancer metastatic spread. Although metastasectomy is the gold standard for fit patients with resectable colorectal cancer liver metastases (CRLMs), their management after surgical treatment remains controversial. The objective of this systematic review was to collate the currently available data of the agents used in the adjuvant setting in order to define the most optimal therapeutic strategy. A systematic review of the literature was conducted by searching PubMed/Medline and Cochrane library databases. We included studies that evaluated the efficacy, the tolerability and the safety profile of various chemotherapeutic agents that are used as adjuvant treatment after surgical resection of CRLMs. The outcomes of interest were regression-free survival (RFS), disease-free survival (DFS), overall survival (OS) and severe toxicities. From 543 initial articles, 29 publications with 7028 patients were finally included. In general, the results of the eligible studies indicated that adjuvant therapy after resection of CRLMs led to improved RFS/DFS rates, but this benefit did not contribute to a statistically significant prolongation of OS. Moreover, the choice of the therapeutic strategy, namely systematic or regional chemotherapy or the combination of both, did not seem to have a differential impact on patient outcomes. However, these results should be interpreted with caution since the majority of the chosen studies are of low or moderate quality. In this context, further high-quality clinical trials conducted on patient sub-populations with modern therapies are required in order to reduce in-study and between-study heterogeneity and determine which patients are expected to derive the maximum benefit from adjuvant therapy after surgery for CRLMs. |
| first_indexed | 2024-03-11T06:22:31Z |
| format | Article |
| id | doaj.art-d7640321c8cc4148b5404124570dae6a |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T06:22:31Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d7640321c8cc4148b5404124570dae6a2023-11-17T11:52:22ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01126240110.3390/jcm12062401Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic ReviewEmmanouil Georgilis0Maria Gavriatopoulou1Diamantis I. Tsilimigras2Panagiotis Malandrakis3Theodosios Theodosopoulos4Ioannis Ntanasis-Stathopoulos5Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, GreeceDepartment of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, GreeceDepartment of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USADepartment of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, GreeceSecond Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, 11528 Athens, GreeceDepartment of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, GreeceThe liver is the most common site of colorectal cancer metastatic spread. Although metastasectomy is the gold standard for fit patients with resectable colorectal cancer liver metastases (CRLMs), their management after surgical treatment remains controversial. The objective of this systematic review was to collate the currently available data of the agents used in the adjuvant setting in order to define the most optimal therapeutic strategy. A systematic review of the literature was conducted by searching PubMed/Medline and Cochrane library databases. We included studies that evaluated the efficacy, the tolerability and the safety profile of various chemotherapeutic agents that are used as adjuvant treatment after surgical resection of CRLMs. The outcomes of interest were regression-free survival (RFS), disease-free survival (DFS), overall survival (OS) and severe toxicities. From 543 initial articles, 29 publications with 7028 patients were finally included. In general, the results of the eligible studies indicated that adjuvant therapy after resection of CRLMs led to improved RFS/DFS rates, but this benefit did not contribute to a statistically significant prolongation of OS. Moreover, the choice of the therapeutic strategy, namely systematic or regional chemotherapy or the combination of both, did not seem to have a differential impact on patient outcomes. However, these results should be interpreted with caution since the majority of the chosen studies are of low or moderate quality. In this context, further high-quality clinical trials conducted on patient sub-populations with modern therapies are required in order to reduce in-study and between-study heterogeneity and determine which patients are expected to derive the maximum benefit from adjuvant therapy after surgery for CRLMs.https://www.mdpi.com/2077-0383/12/6/2401colorectal cancer liver metastasesliver metastasectomyadjuvant therapysystematic chemotherapyhepatic arterial infusion chemotherapysystematic review |
| spellingShingle | Emmanouil Georgilis Maria Gavriatopoulou Diamantis I. Tsilimigras Panagiotis Malandrakis Theodosios Theodosopoulos Ioannis Ntanasis-Stathopoulos Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review Journal of Clinical Medicine colorectal cancer liver metastases liver metastasectomy adjuvant therapy systematic chemotherapy hepatic arterial infusion chemotherapy systematic review |
| title | Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review |
| title_full | Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review |
| title_fullStr | Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review |
| title_full_unstemmed | Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review |
| title_short | Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review |
| title_sort | optimizing adjuvant therapy after surgery for colorectal cancer liver metastases a systematic review |
| topic | colorectal cancer liver metastases liver metastasectomy adjuvant therapy systematic chemotherapy hepatic arterial infusion chemotherapy systematic review |
| url | https://www.mdpi.com/2077-0383/12/6/2401 |
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