Rectal and hepatic resection for rectal cancer with synchronous liver metastases (RESECT): simultaneous vs. staged. A systematic review

Abstract

Objective: Staged surgical resection has been the preferred approach to treat synchronous rectal cancer with liver metastases; however, newer reports suggest that simultaneous resection is feasible and safe. This systematic review seeks to determine differences in overall post-operative complications (primary outcome) between staged and simultaneous resections. Methods: We searched Medline, Embase, and PubMed for all study designs comparing simultaneous (intervention) versus staged (control) resection of synchronous rectal cancer with liver metastases. Study selection, data abstraction, risk of bias and quality of the evidence assessment were carried out in duplicate. Major complications were a secondary outcome. Risk of bias was assessed using the tool designed by the CLARITY Group. The quality of evidence was assessed using GRADE. Statistical heterogeneity was calculated using chi-squared and I2. Clinical heterogeneity was explored via subgroup analyses. The protocol was published in PROSPERO. Results: Of the 4456 abstracts retrieved, 17 studies were analyzed and 6 reported the primary outcome (all retrospective cohort studies). There were 288 intervention and 287 control patients in total. The odds ratio (OR) for overall complications (Intervention vs. Control) was 0.93, 95% confidence interval (CI) 0.64–1.35; the OR for major complications was 0.83, 95% CI 0.41–1.65. There wsas no significant statistical or clinical heterogeneity. Overall, the risk of bias for the included studies was moderate and the quality of the evidence (GRADE) was very low. Conclusion: Simultaneous resection of synchronous rectal cancer with liver metastases carries a similar risk of overall and major complications compared to the staged approach. Evidence from randomized trials is needed.