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Systematic review and meta‐analysis of follow‐up after hepatectomy for colorectal liver metastases. BJS 2012; 99: 477-486.

Published: 19th January 2012

Authors: R. P. Jones, R. Jackson, D. F. J. Dunne, H. Z. Malik, S. W. Fenwick, G. J. Poston et al.

Background

The evidence surrounding optimal follow‐up after liver resection for colorectal metastases remains unclear. A significant proportion of recurrences occur in the early postoperative period, and some groups advocate more intensive review at this time.

Method

A systematic review of literature published between January 2003 and May 2010 was performed. Studies that described potentially curative primary resection of colorectal liver metastases that involved a defined follow‐up protocol and long‐term survival data were included. For meta‐analysis, studies were grouped into intensive (more frequent review in the first 5 years after resection) and uniform (same throughout) follow‐up.

Results

Thirty‐five studies were identified that met the inclusion criteria, involving 7330 patients. Only five specifically addressed follow‐up. Patients undergoing intensive early follow‐up had a median survival of 39·8 (95 per cent confidence interval 34·3 to 45·3) months with a 5‐year overall survival rate of 41·9 (34·4 to 49·4) per cent. Patients undergoing routine follow‐up had a median survival of 40·2 (33·4 to 47·0) months, with a 5‐year overall survival rate of 38·4 (32·6 to 44·3) months.

Conclusion

Evidence regarding follow‐up after liver resection is poor. Meta‐analysis failed to identify a survival advantage for intensive early follow‐up. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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