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Updated: Jun 17, 2026
Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis
Published on: March 3, 2023
Systematic Review and Meta-Analysis of Resection Sequence in Synchronous Colorectal Liver Metastasis: Primary vs.
Sofoklis Mavrantonis1, Omar Abou El-Wafa2, Sascha Vaghiri2
1General Surgery Service, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
Background:
This present systematic review and meta-analysis aims to compare overall survival (OS), disease-free survival (DFS), morbidity and mortality outcomes in patients undergoing colorectal first (CRf) versus liver first (Lf) resections with synchronous colorectal liver metastases.
Methodology:
A literature search was performed in PubMed, Cochrane Central trials register, and Google Scholar databases. This was conducted in line with current PRISMA guidelines. 95% confidence intervals were calculated for the primary endpoints and odds ratios for secondary endpoints. The Cochrane Q test and the measurement of inconsistency test were used to assess the degree of heterogeneity among the included studies.
Results:
Fifteen studies were included with a total of 8611 patients from 2010 to 2025. A statistically significant survival benefit was seen in the overall 1-year survival of the CRf group compared to the Lf group, with no significant difference in 3- and 5-year follow-up. In addition, a statistically significant benefit in 1-, 3-, and 5- year DFS rates was seen in the CRf group when compared to the Lf group. No significant difference was seen in major morbidity and 90-day mortality, and failure to proceed to the second resection stage.
Conclusion:
DFS was significantly increased in the CRf group compared to the Lf group, with no difference in secondary outcomes. One-year OS was also found to be higher in the CRf group; however, this finding likely reflects the heterogeneity of the included studies and perioperative course after hepatic resections. To our knowledge, this is the first meta-analysis to demonstrate such a significant difference of one strategy over the other. However, caution should be used in the interpretation of these results due to the lack of available randomized control trials.
