Introduction
Materials and methods
Literature search strategy
Inclusion and exclusion criteria
Data extraction
Quality assessment
Statistical analysis
Sensitivity analysis and publication bias
Result
Included studies and quality assessment
Characteristics of the included studies
First Author (Year) | Enrollment period | Country | Group | No. of patients | Gender (Male%) | Age | Primary tumor (Colon/ Rectum) | Number of metastases | Largest metastasis size(cm) | Synchronous liver metastases (%) | CEA level (ng/mL) | Type of survival outcomes | Follow-up (months) | NOS |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Andreou 2021 [9] | 2012–2019 | Switzerland | AR | 13 | 9(69.2%) | 61(30–79) | 9/4 | N/A | N/A | 9(100%) | N/A | OS, RFS | 55 | 8 |
PSR | 79 | 51(64.6%) | 62(36–84) | 59/20 | N/A | N/A | 45(57%) | N/A | ||||||
Dam 2014 [25] | 1991–2010 | The Netherlands | AR | 129 | 67(51.9%) | 64(24–82) | 79/50 | 4(1–12) | 3.0(0.0–20.0) | N/A | N/A | OS, DFS | 33(0–235) | 8 |
PSR | 169 | 110(65.1%) | 64(28–88) | 98/71 | 1(1–3) | 3.0(0.4–13.0) | N/A | N/A | ||||||
DeMatteo 2000 [17] | 2001–2013 | Italy | AR | 148 | 88(59%) | < 70:110(74%); > 70:38(26%) | 110/38 | > 1:30(20%) | ≥ 5 cm:48(32%) | N/A | < 200:101(92%); ≥ 200:9(8%) | OS | 25(1–140) | 7 |
PSR | 119 | 67(56%) | < 70:83(70%); > 70:36(30%) | 96/33 | > 1:23(19%) | ≥ 5 cm:19(16%) | N/A | < 200:84(90%); ≥ 200:9(10%) | ||||||
Donadon 2018 [31] | 2001–2013 | Italy | AR | 110 | 67(60%) | 63.8 ± 10.2 | N/A | 3.5 ± 2.6 | 4.9 ± 2.5 | 44(40%) | N/A | OS, DFS | 33(1–83) | 8 |
PSR | 110 | 74(67%) | 61.9 ± 11.0 | N/A | 3.7 ± 3.3 | 4.5 ± 2.5 | 43(39%) | N/A | ||||||
Finch 2007 [21] | 1993–2003 | UK | AR | 280 | 171(61%) | 63(26–84) | N/A | 2(1–14) | 4.5(0.7–20) | 117(41.8%) | 18 ng/dl(1–37,140) | OS, DFS | 33(24–144) | 7 |
PSR | 96 | 64(67%) | 63(24–79) | N/A | 1(1–9) | 3.3(0.4–15) | 36(38%) | 5 ng/dl(1–12,124) | ||||||
Guzzetti 2008 [22] | 1996–2005 | Italy | AR | 102 | 58(56.8%) | < 70:78(76.4%); > 70: 24(23.6%) | 55/21 | Single 59(61.4%); Multiple 37(38.6%) | > 5 cm:31(32.3) | N/A | < 200:52(89.6); ≥ 200:6(10.4) | OS, DFS | N/A | 8 |
PSR | 106 | 63(59.5%) | < 70: 77(72.6%); > 70: 29(27.4%) | 60/31 | Single 67(64.4%); Multiple 37(35.6%) | > 5 cm:21(20.8) | N/A | < 200:51(86.4); ≥ 200:8(13.6) | ||||||
Hosokawa 2017 [29] | 2000–2015 | France | AR | 242 | 141(58%) | 64.0 ± 10.0 | 158/84 | N/A | 2.04 ± 0.8 | 121(50%) | 159.7 ± 1,347.6 | OS, RFS | 41 | 8 |
PSR | 1478 | 888(60%) | 64.1 ± 11.0 | 980/498 | N/A | 1.93 ± 0.76 | 721(49%) | 65.7 ± 303.0 | ||||||
Joechle 2020 [34] | 2006–2016 | USA | AR | 105 | 69(65.7%) | 54(29–82) | 72/33 | 1(1–9) | 2.0(0.16–5.3) | 75(71%) | N/A | OS, RFS, liver-RFS | 43.1 | 7 |
PSR | 105 | 71(67.6%) | 56(26–79) | 82/23 | 1(1–8) | 1.8(0.1–5.8) | 81(77%) | N/A | ||||||
Kokudo 2001 [18] | 1980–1999 | Japan | AR | 96 | 54(56.3%) | 58.7 ± 1.0 | 71/25 | Single:54(56.3%); ≥ 3:20(20.8%) | 5.81 ± 0.4 | 46(47.9%) | N/A | OS | N/A | 7 |
PSR | 78 | 46(59%) | 60.3 ± 1.2 | 49/29 | Single:42(53.8%); ≥ 3:19(24.4%) | 2.69 ± 0.16 | 56(71.8%) | N/A | ||||||
Lalmahomed 2011 [24] | 2000–2008 | Netherlands | AR | 88 | 56(64%) | 65(30–82) | 55/33 | 2(1–7) | 4(1–15) | 35(40%) | > 200:10(12%) | OS, DFS | 35(1–111) | 8 |
PSR | 113 | 70(62%) | 65(36–86) | 59/54 | 1(1–7) | 3(1–7) | 43(38%) | > 200:6(5%) | ||||||
Lordan 2017 [30] | 2000–2010 | UK | AR | 238 | 130(54.6%) | 64.8(24–86) | N/A | Single:161(67.7%); Mutiple:76(31.9%) | 3.2(0.4–20) | 14 (5.9) | N/A | OS, DFS | 36(0.12–144) | 8 |
PSR | 238 | 135(56.7%) | 65.7(31–87) | N/A | Single:153(64.3%); Mutiple:85(35.7%) | 3.1(0.5–14) | 15 (6.3) | N/A | ||||||
Matsuki 2016 [26] | 2005–2013 | Japan | AR | 23 | 17(74%) | 62(29–84) | 15/8 | 5(1–17) | 2.0(0.5–3) | 13(57) | 4.9(0.6–230) | OS, RFS, Liver-RFS | 40(5–81) | 8 |
PSR | 40 | 25(63%) | 64(40–81) | 26/14 | 4(1–27) | 1.8(0.5–3) | 18(45) | 4.2(0.5–117) | ||||||
Matsumura 2016 [27] | 1999–2012 | Japan | AR | 32 | 22(68.8) | 62.5(27–80) | 22/10 | 7(4–31) | 3.0(0.8–5) | N/A | 9.35(0.6–975) | OS, RFS, Liver-RFS | N/A | 7 |
PSR | 113 | 74(65.5) | 60(40–81) | 65/48 | 6(4–33) | 2.5(0.4–5) | N/A | 7(0.5–3097) | ||||||
Memeo 2016 [28] | 2006–2013 | France | AR | 266 | 145(55%) | 61(29–82) | 189/77 | 4(3–15) | 3.3(0.6–20) | 127(48%) | N/A | OS, DFS | N/A | 8 |
PSR | 266 | 146(55%) | 62.4(40–80) | 194/72 | 4(3–9) | 3.5(0.6–11) | 134(50%) | N/A | ||||||
Mise 2016 [8] | 1993–2013 | Houston | AR | 144 | 80(56%) | 58(22–87) | 105/39 | N/A | 1.9(0.3–3.0) | 17(12%) | 2.9(0.4–250.3) | OS, RFS, Liver-RFS | 37(2—208) | 8 |
PSR | 156 | 94(61%) | 60(30–88) | 113/43 | N/A | 1.5(0.4–3.0) | 50(32%) | 2.5(0.4–430.9) | ||||||
Okumura 2019 [10] | 2004–2017 | France | AR | 82 | 51(62.2%) | 64(43–85) | 55/27 | 2(1–8) | 2.8(0.5–13) | 50(61%) | N/A | OS, RFS, Liver-RFS | 33.9(6–120) | 8 |
PSR | 82 | 50(61%) | 65(33–83) | 48/34 | 2(1–7) | 2.5(0.5–15) | 45(54.9%) | N/A | ||||||
Pandanaboyana 2018 [32] | 1993–2011 | UK | AR | 582 | N/A | < 65:282(48.5%); > 65:300(51.5%) | N/A | 2 | 4.5(3–7) | 294(50.5%) | N/A | OS, DFS | 32.2(17.5–56.9) | 8 |
PSR | 409 | N/A | < 65:175(42.8%); > 65:234(57.2%) | N/A | 2 | 2.7(2–4) | 228(55.7%) | N/A | ||||||
Sarpel 2009 [23] | 1987–2007 | USA | AR | 94 | 54(57%) | 60.8 ± 10.4 | 60/10 | 1.7 ± 1.2 | 6.6 ± 4.7 | 8(8%) | N/A | OS, DFS | 34 | 8 |
PSR | 89 | 51(57%) | 62.3 ± 11.6 | 59/12 | 1.4 ± 1.0 | 3.5 ± 2.3 | 8(9%) | N/A | ||||||
She 2020 [35] | 1990–2017 | China | AR | 70 | 38(54.3%) | 61.0(29–85) | N/A | 1(1–7) | 2.45(1.0–11.0) | 38(55.1%) | 8.8(0.7–802) | OS, DFS | 39.8(2.9–183.9) | 8 |
PSR | 70 | 47(67.1%) | 61.0(31–85) | N/A | 1(1–multiple) | 2.5(0.9–11.0) | 27(38.6%) | 8.85(1–526) | ||||||
Spelt 2018 [33] | 2006–2014 | Sweden | AR | 60 | 39(65%) | 65(61–69) | N/A | 3(2–5) | 2.65(1.7–4.0) | 38(64.4%) | 5(3–18) | OS | 35 | 7 |
PSR | 59 | 35(59.3%) | 69(63–76) | N/A | 2(2–4) | 2.2(1.5–3.0) | 29(51.8%) | 5(3–17) | ||||||
Stewart 2004 [19] | 1988–2001 | UK | AR | 69 | N/A | 62(23–79) | N/A | 1–3:65(97%); > 3:2/67(3%) | < 5 cm:14(23.3%); > 5 cm:46(76.7%) | N/A | 625U/l(14–308,040) | OS | N/A | 7 |
PSR | 27 | N/A | 64(28–82) | N/A | 1–3:22(91.7%); > 3:2(8.3%) | < 5 cm:14(77.7%); > 5 cm:4(22.3%) | N/A | 105U/l(1–2662) | ||||||
Zorzi 2006 [20] | 1991–2004 | Italy | AR | 181 | 113(62.4%) | < 65:120(66.3%); > 65:61(33.7%) | 113/46 | Single:99(54.7%); Multiple:82(45.3%) | 3(0.3–18) | 73(40.3%) | < 200:160(88.4%); > 200:7(3.9%) | OS | 25 | 7 |
PSR | 72 | 46(64%) | < 65:44(61%); > 65:28(39%) | 42/17 | Single:45(62.5%); Multiple:27(37.5%) | 2.1(0.5–6) | 25(34.7%) | < 200:63(87.5%); > 200:1(1.4%) |
Overall survival (OS)
Patients | Study heterogeneity | |||||||
---|---|---|---|---|---|---|---|---|
Outcomes of interest | Studies | AR | PSR | WMD/RR/HR (95% CI) | P value | I2(%) | P value | Effect model |
Long-term | ||||||||
Overall survial (OS) | 22 | 3154 | 4074 | 1.08(0.95–1.22) | 0.245 | 49.3 | 0.005 | Random |
3‐year OS | 13 | 1668 | 2878 | 0.99(0.92–1.06) | 0.728 | 55.4 | 0.008 | Random |
5‐year OS | 18 | 2760 | 3692 | 0.93(0.86–1.00) | 0.054 | 44.9 | 0.021 | Random |
Disease‐free survival (DFS) | 14 | 2260 | 3368 | 1.09(0.94–1.28) | 0.259 | 75.1 | < 0.001 | Random |
3‐year DFS | 10 | 1237 | 2581 | 0.98(0.89–1.07) | 0.66 | 0 | 0.897 | Fixed |
5‐year DFS | 14 | 2260 | 3368 | 0.88(0.73–1.07) | 0.212 | 70.1 | < 0.001 | Random |
3‐year Liver-RFS | 5 | 386 | 496 | 1.02(0.9–1.15) | 0.789 | 0 | 0.79 | Fixed |
5‐year Liver-RFS | 5 | 386 | 496 | 1.00(0.88–1.14) | 0.981 | 0 | 0.592 | Fixed |
Short‐term | ||||||||
Duration of operation (min) | 13 | 1234 | 1364 | 51.48(29.03–73.93) | < 0.001 | 98.6 | < 0.001 | Random |
Estimated blood loss (mL) | 10 | 886 | 992 | 189.92(21.39–358.45) | 0.027 | 98.6 | < 0.001 | Random |
Intraoperative blood transfusion | 12 | 1799 | 3004 | 2.24(1.54–3.26) | < 0.001 | 74 | < 0.001 | Random |
Length of hospital stay (day) | 15 | 1813 | 3011 | 1.00(0.34–1.67) | 0.003 | 66.6 | < 0.001 | Random |
Positive margin (mm) | 12 | 1244 | 1080 | 0.77(0.61–0.97) | 0.024 | 33.9 | 0.119 | Fixed |
Postoperative complications | 12 | 1880 | 3116 | 2.28(1.88–2.77) | < 0.001 | 0 | 0.639 | Fixed |
90‐day mortality | 7 | 1711 | 2826 | 3.08(1.88–5.03) | < 0.001 | 0 | 0.796 | Fixed |
Intrahepatic recurrence | 15 | 2299 | 2036 | 0.90(0.82–0.98) | 0.021 | 26.2 | 0.166 | Fixed |
Repeat hepatectomy | 14 | 2362 | 3398 | 0.64(0.55–0.76) | < 0.001 | 12.4 | 0.317 | Fixed |