Simultaneous versus staged major hepatectomy (>= 3 liver segments) for outcomes of synchronous colorectal liver metastases: A systematic review and meta-analysis

Background Hepatectomy is an effective treatment for synchronous colorectal liver metastases (SCLM) patients. However, whether to choose simultaneous hepatectomy (SIH) or staged hepatectomy (STH) is still controversial, especially during major hepatectomy (>= 3 liver segments). Aims Compare the difference between the SCLM patients underwent SIH and STH, especially during major hepatectomy (>= 3 liver segments). Methods and Results A meta-analysis was conducted by analyzing the published data on the outcomes of SCLM patients underwent SIH or STH from January 2010 to December 2020 from the electronic databases. A random-effects model was used to derive pooled estimates of odds ratio (OR) with 95% confidence interval (CI) for the explored outcomes. Eventually, 18 studies, including 5101 patients, were included this study. The result of meta-analysis showed that SIH did not increase postoperative complications (pooled OR: 1.037; 95% CI: 0.897-1.200), perioperative mortality (pooled OR: 0.942; 95% CI: 0.552-1.607), 3-year mortality (pooled OR: 1.090; 95% CI: 0.903-1.316) or 5-year mortality (pooled OR: 1.077; 95% CI: 0.926-1.253), as compared with STH. Subgroup analysis showed that, simultaneous major hepatectomy (SIMH) also did not increase postoperative complications (pooled OR: 0.863; 95% CI: 0.627-1.188) or perioperative mortality (pooled OR: 0.689; 95% CI: 0.290-1.637) as compared with staged major hepatectomy (STMH). Conclusion Postoperative complications, perioperative mortality and long-term prognosis had no significant difference between SIH and STH for SCLM patients. Besides, postoperative complications and perioperative mortality also had no significant difference between SIMH and STMH.