Abstract
IntroductionLiver 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.MethodsThis 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.DiscussionThe 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 registrationPROSPERO registration number: CRD42020178481 (July 5, 2020).
Highlights
Liver resection (LR) in patients with liver metastasis from colorectal cancer remains the only curative treatment
The majority of Colorectal cancer liver metastases (CRCLM) patients who reach LR will have received some form of neoadjuvant chemotherapy
The main objective is to assess the effects of neoadjuvant chemotherapy on liver regeneration after LR or portal vein embolization (PVE) in patients with CRCLM when compared to patients without chemotherapy before the procedure
Summary
Liver resection (LR) in patients with liver metastasis from colorectal cancer remains the only curative treatment. 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. More than 50% of the patients diagnosed with colorectal cancer will develop metastases in the course of their disease [2]. Of these metastases, 20–30% will be confined exclusively in the liver (CRCLM) [3]. Current guidelines recommend preoperative chemotherapy for the majority of CRCLM patients with resectable disease [4, 5]. The majority of CRCLM patients who reach LR will have received some form of neoadjuvant chemotherapy
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