热消融联合肝切除术与单纯肝切除术治疗多发性结直肠癌肝转移的比较结果：一项系统评价和荟萃分析
Comparative outcomes of combined thermal ablation and liver resection versus liver resection alone for multiple colorectal liver metastases: a systematic review and meta-analysis.
作者信息
Meng Zesong, Li Baokun, Zhou Chaoxi, Cao Longfei, Zhang Jianfeng, Feng Jun, Wang Guiying
机构信息
Department of General Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
出版信息
Front Oncol. 2025 Jun 27;15:1613615. doi: 10.3389/fonc.2025.1613615. eCollection 2025.
BACKGROUND
The treatment of colorectal liver metastases (CRLM) continues to pose a significant clinical challenge, with surgical resection remaining the gold standard. However, the efficacy of combining thermal ablation (TA) with liver resection (LR) compared to LR alone in managing multifocal CRLM remains a topic of debate. This meta-analysis aims to compare the outcomes of combining TA and LR with LR alone in patients with multifocal CRLM.
METHODS
A comprehensive literature search was conducted across PubMed, EMBASE, Cochrane Library, and Web of Science up to December 2024. Studies that compared the combination of TA and LR with LR alone in patients with CRLM and reported at least 1-, 2-, or 3-year overall survival (OS) and/or disease-free survival (DFS) were included. Data were extracted and analyzed using random-effects or fixed-effects models, depending on the degree of heterogeneity. Sensitivity analysis and assessment of publication bias were performed to ensure the robustness of the findings.
RESULTS
Six retrospective cohort studies involving 3084 patients (1286 in the TA+LR group and 1798 in the LR group) were included. No significant differences were found in 1-, 2-, and 3-year OS between the TA+LR and LR groups. However, the TA+LR group exhibited worse DFS. Subgroup analysis revealed a more pronounced decline in DFS in non-European TA+LR cohorts compared to LR cohorts, potentially reflecting regional differences. Additionally, DFS was significantly lower in the radiofrequency ablation (RFA) subgroup compared to the microwave ablation (MWA) subgroup. Complication rates were comparable between the two groups. Sensitivity analysis confirmed the stability of the results, and no significant publication bias was detected.
CONCLUSION
Combining thermal ablation with liver resection is a feasible liver-sparing approach for treating extensive CRLM, applicable through both laparoscopic and open surgical techniques. Combined resection and ablation should be considered as an alternative to resection alone for patients with multiple metastases.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42024629343.
背景
结直肠癌肝转移（CRLM）的治疗仍然是一项重大的临床挑战，手术切除仍是金标准。然而，与单纯肝切除（LR）相比，热消融（TA）联合肝切除（LR）在治疗多灶性CRLM中的疗效仍是一个有争议的话题。本荟萃分析旨在比较TA联合LR与单纯LR治疗多灶性CRLM患者的结局。
方法
截至2024年12月，在PubMed、EMBASE、Cochrane图书馆和科学网进行了全面的文献检索。纳入比较TA联合LR与单纯LR治疗CRLM患者且报告了至少1年、2年或3年总生存期（OS）和/或无病生存期（DFS）的研究。根据异质性程度，使用随机效应或固定效应模型提取和分析数据。进行敏感性分析和发表偏倚评估以确保研究结果的稳健性。
结果
纳入了6项回顾性队列研究，共3084例患者（TA+LR组1286例，LR组1798例）。TA+LR组和LR组在1年、2年和3年OS方面未发现显著差异。然而，TA+LR组的DFS较差。亚组分析显示，与LR队列相比，非欧洲TA+LR队列的DFS下降更为明显，这可能反映了地区差异。此外，射频消融（RFA）亚组的DFS显著低于微波消融（MWA）亚组。两组的并发症发生率相当。敏感性分析证实了结果的稳定性，未检测到显著的发表偏倚。
结论
热消融联合肝切除是一种可行的保留肝脏的方法，可用于治疗广泛的CRLM，可通过腹腔镜和开放手术技术实施。对于有多处转移的患者，联合切除和消融应被视为单纯切除的替代方案。
系统评价注册
PROSPERO https://www.crd.york.ac.uk/prospero/，标识符CRD42024629343。
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