Journal Article

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

Kreis, Martin E., Pawlik, Timothy M., Papaconstantinou, Dimitrios, Buettner, Stefan, Wang, Jane, Margonis, Georgios Antonios, Belias, Michail, Pararas, Nikolaos, Beyer, Katharina, Pozios, Ioannis, Stasinos, Georgios, Pikouli, Anastasia, Dellaportas, Dionysios, Pikoulis, Emmanouil, Antoniou, Efstathios

2024

Overview

Background Although some data suggest that patients with mut RAS 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 mut RAS vs. 1187 wt RAS ) 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 mut RAS tumors; in contrast, AR was not associated with any improvement in liver-specific DFS or overall DFS among wt RAS patients. These differences may have been mediated by the 40% decreased incidence in R1 resection among patients with mut RAS 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 wt RAS 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 mut RAS tumors.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Colorectal Neoplasms - pathology / Colorectal Neoplasms - surgery / Hepatectomy / Hepatectomy - methods / Hepatectomy - mortality / Hepatobiliary Tumors / Humans / Liver / Liver diseases / Liver Neoplasms - secondary / Liver Neoplasms - surgery / Medical prognosis / Medicine / Medicine & Public Health / Meta-analysis / Metastases / Metastasis / Mutation / Oncology / Precision Medicine / Prognosis / Surgery / Surgical Oncology / Surgical techniques / Survival Rate / Systematic review / Tumors