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Is Precision Surgery Applicable to Colorectal Liver Metastases? A Systematic Review and Meta-analysis of Studies that Investigate the Association of Surgical Technique with Outcomes in the Context of Distinct Tumor Biology.
Pikoulis, Emmanouil; Papaconstantinou, Dimitrios; Pikouli, Anastasia; Pararas, Nikolaos; Buettner, Stefan; Wang, Jane; Stasinos, Georgios; Belias, Michail; Dellaportas, Dionysios; Pozios, Ioannis; Antoniou, Efstathios; Beyer, Katharina; Kreis, Martin E; Pawlik, Timothy M; Margonis, Georgios Antonios.
Afiliación
  • Pikoulis E; Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Papaconstantinou D; Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Pikouli A; Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Pararas N; Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Buettner S; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
  • Wang J; Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
  • Stasinos G; Technical Chamber of Greece, Athens, Greece.
  • Belias M; Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Dellaportas D; Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Pozios I; Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany.
  • Antoniou E; Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
  • Beyer K; Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany.
  • Kreis ME; Department of General and Visceral Surgery, Charité Campus Benjamin Franklin, Berlin, Germany.
  • Pawlik TM; Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
  • Margonis GA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. margonig@mskcc.org.
Ann Surg Oncol ; 31(3): 1823-1832, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38155339
ABSTRACT

BACKGROUND:

Although some data suggest that patients with mutRAS colorectal liver metastases (CRLM) may benefit from anatomic hepatectomy, this topic remains controversial. We performed a systematic review and meta-analysis to determine whether RAS mutation status was associated with prognosis relative to surgical technique [anatomic resection (AR) vs. nonanatomic resection (NAR)] among patients with CRLM. PATIENTS AND

METHODS:

A systematic review and meta-analysis of studies were performed to investigate the association of AR versus NAR with overall and liver-specific disease-free survival (DFS and liver-specific DFS, respectively) in the context of RAS mutation status.

RESULTS:

Overall, 2018 patients (831 mutRAS vs. 1187 wtRAS) were included from five eligible studies. AR was associated with a 40% improvement in liver-specific DFS [hazard ratio (HR) = 0.6, 95% confidence interval (CI) 0.44-0.81, p = 0.01] and a 28% improvement in overall DFS (HR = 0.72, 95% CI 0.54-0.95, p = 0.02) among patients with mutRAS tumors; in contrast, AR was not associated with any improvement in liver-specific DFS or overall DFS among wtRAS patients. These differences may have been mediated by the 40% decreased incidence in R1 resection among patients with mutRAS tumors who underwent AR versus NAR [relative risk (RR) 0.6, 95% CI 0.40-0.91, p = 0.02]. In contrast, the probability of an R1 resection was not decreased among wtRAS patients who underwent AR versus NAR (RR 0.93, 95% CI 0.69-1.25, p = 0.62).

CONCLUSIONS:

The data suggest that precision surgery may be relevant to CRLM. Specifically, rather than a parenchymal sparing dogma for all patients, AR may have a role in individuals with mutRAS tumors.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias Colorrectales / Hepatectomía / Neoplasias Hepáticas Tipo de estudio: Systematic_reviews Límite: Humans Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Grecia

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias Colorrectales / Hepatectomía / Neoplasias Hepáticas Tipo de estudio: Systematic_reviews Límite: Humans Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Grecia