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Meta-analysis of survival outcomes following surgical and non surgical treatments for colorectal cancer metastasis to the lung

Lookup NU author(s): John Hammond, Steven White, Jeremy French, Professor Derek Manas, Sanjay PandanaboyanaORCiD


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© 2020 Royal Australasian College of Surgeons. Background: Controversy exists regarding the optimal management of colorectal lung metastases (CRLM). This meta-analysis compared surgical (Surg) versus interventional (chemotherapy and/or radiotherapy) and observational non-surgical (NSurg) management of CRLM. Methods: A systematic review of the major databases including Medline, Embase, SCOPUS and the Cochrane library was performed. Results: One randomized and nine observational studies including 2232 patients: 1551 (69%) comprised the Surg cohort, 521 (23%) the interventional NSurg group and 160 (7%) the observational NSurg group. A significantly higher overall survival (OS) was observed when Surg was compared to interventional NSurg at 1 year (Surg 88%, 310/352; interventional NSurg 64%, 245/383; odds ratio (OR) 2.77 (confidence interval (CI) 1.94–3.97), P = 0.001), at 3 years (Surg 59%, 857/1444; interventional NSurg 26%, 138/521; OR 2.61 (CI 1.65–4.15), P = 0.002), at 5 years (Surg 47%, 533/1144; interventional NSurg 23%, 45/196; OR 3.24 (CI 1.42–7.39), P = 0.009) and at 10 years (Surg 27%, 306/1122; interventional NSurg 1%, 2/168; OR 15.64 (CI 1.87–130.76), P = 0.031). Surg was associated with a greater OS than observational NSurg at only 1 year (Surg 92%, 98/107; observational NSurg 83%, 133/160; OR 6.69 (CI 1.33–33.58), P = 0.037) and was similar to observational NSurg at all other OS time points. Comparable survival was observed among Surg and overall NSurg cohorts at 3- and 5-year survival in articles published within the last 3 years. Conclusions: Recent evidence suggests comparable survival with Surg and NSurg modalities for CRLM, contrasting to early evidence where Surg had an improved survival. Significant selection bias contributes to this finding, prompting the need for high powered randomized controlled trials and registry data.

Publication metadata

Author(s): Ratnayake CBB, Wells CI, Atherton P, Hammond JS, White S, French JJ, Manas D, Pandanaboyana S

Publication type: Review

Publication status: Published

Journal: ANZ Journal of Surgery

Year: 2021

Volume: 91

Issue: 3

Pages: 255-263

Print publication date: 01/03/2021

Online publication date: 22/10/2020

Acceptance date: 20/09/2020

ISSN (print): 1445-1433

ISSN (electronic): 1445-2197

Publisher: Blackwell Publishing


DOI: 10.1111/ans.16383