Neoadjuvant chemotherapy versus upfront surgery for resectable colorectal liver metastases: A systemic review and meta-analysis

Abstract

Aim: To compare the differences between neoadjuvant chemotherapy with resection and upfront surgery for patients with resectable colorectal cancer with liver metastases.

Patients and Methods: The following electronic databases were searched for systematic literature: PubMed, Cochrane Library and Google Scholar. Studies fulfilling the following criteria were included in the analysis: compared neoadjuvant chemotherapy and upfront surgery; included patients with resectable metastases at the time of presentation; reported the long-term results, including overall survival (OS) and disease-free survival (DFS); and identified early adverse postoperative events, including 30-day mortality and overall postoperative complications.

Results: Over 24 studies with 8700 patients were analysed. Patients were divided into the neoadjuvant chemotherapy group (n = 3490, 40.1%) and the upfront surgery group (n = 5172, 59.4%). The meta-analysis showed no statistically significant difference in terms of overall morbidities [odds ratio (OR) 1.19, 95% confidence interval (CI) 0.84-1.67] and mortality (OR 1.48, 95% CI 0.75-2.92) between the neoadjuvant chemotherapy and upfront surgery groups. However, the meta-analysis showed a favourable OS in the upfront surgery group (OR 1.21, 95% CI 1.06-1.38) and favourable DFS in the upfront surgery group (OR 1.71, 95% CI 1.38-2.12), including the subgroups of 1-, 3-, 5-year DFS (OR 1.38, 95% CI 1.06-1.8; OR 2.06, 95% CI 1.35-3.14 and OR 1.65, 95% CI 1.18-2.29, respectively).

Conclusion: Neoadjuvant chemotherapy has no benefit for resectable colorectal cancer with liver metastases; therefore, upfront surgery should be considered as the treatment of choice.

Keywords

chemotherapy / colorectal liver metastases / neoadjuvant / surgery / upfront surgery

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