Department of Surgery, Liver, Biliary and Pancreatic Unit, Hospital Clínico, University of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain.
Department of Anaesthesiology, Hospital de Manises, Valencia, Spain.
Ann Surg. 2019 Dec;270(6):1018-1027. doi: 10.1097/SLA.0000000000003254.
To study the effect of postoperative complications (POC) on overall survival (OS) and disease-free survival (DFS) after surgical resection of colorectal liver metastases (CRLM).
Morbidity rates after liver resection can reach 45%. The negative impact of POC on oncologic outcomes has been reported in various types of cancer, especially colorectal. However, data on the consequences of POC after CRLM resection on long-term survival are scarce.
Eligible studies examining the association between POC after CRLM resection and OS/DFS were sought using the PubMed and Web of Science databases. A random-effects model was used to calculate pooled effect estimate for OS and DFS hazard ratios (HR), estimating between-study variance with restricted maximum likelihood estimator with Hartung-Knapp adjustment. Subgroup analysis was used to control the effect of POC on OS and DFS for: 1) Method used to define postoperative complications, 2) Exclusion of early postoperative death from survival analysis, 3) Method of data extraction used, and 4) Tumor and treatment characteristics.
Forty-one studies were deemed eligible, including 12,817 patients. POC patients had a significant risk of reduced OS compared with no POC group (HR 1.43 [95% CI: 1.3, 1.57], P < 0.0001). POC had also a negative impact on DFS. The HR for reduced DFS was 1.38 [95% CI 1.27, 1.49], P < 0.0001. The negative impact of POC on survival and recurrence was confirmed in subgroup analysis.
Our findings evidence the negative impact of POC on survival and recurrence after CRLM resection.
研究结直肠癌肝转移（CRLM）术后并发症（POC）对总生存（OS）和无病生存（DFS）的影响。
肝切除术后的发病率可达 45%。POC 对各种类型癌症（尤其是结直肠癌）的肿瘤学结局的负面影响已有报道。然而，关于 CRLM 切除术后 POC 对长期生存影响的数据却很少。
使用 PubMed 和 Web of Science 数据库寻找研究 CRLM 切除术后 POC 与 OS/DFS 之间关系的合格研究。使用随机效应模型计算 OS 和 DFS 风险比（HR）的汇总效应估计值，使用受限极大似然估计法（REML）和 Hartung-Knapp 调整法估计研究间方差。亚组分析用于控制 POC 对 OS 和 DFS 的影响，包括：1）用于定义术后并发症的方法；2）从生存分析中排除早期术后死亡；3）使用的数据提取方法；4）肿瘤和治疗特征。
共纳入 41 项研究，包括 12817 例患者。与无 POC 组相比，POC 患者的 OS 风险显著降低（HR 1.43[95%CI：1.3，1.57]，P<0.0001）。POC 对 DFS 也有负面影响。DFS 降低的 HR 为 1.38[95%CI：1.27，1.49]，P<0.0001。亚组分析证实了 POC 对生存和复发的负面影响。
我们的研究结果表明，POC 对 CRLM 切除术后的生存和复发有负面影响。
