Top

World Journal of Surgical Oncology

Published in:

01-12-2021 | Liver Cirrhosis | Research

Does liver cirrhosis affect the surgical outcome of primary colorectal cancer surgery? A meta-analysis

Authors: Yu-Xi Cheng, Wei Tao, Hua Zhang, Dong Peng, Zheng-Qiang Wei

Published in: World Journal of Surgical Oncology | Issue 1/2021

Abstract

Purpose

The purpose of this meta-analysis was to evaluate the effect of liver cirrhosis (LC) on the short-term and long-term surgical outcomes of colorectal cancer (CRC).

Methods

The PubMed, Embase, and Cochrane Library databases were searched from inception to March 23, 2021. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of enrolled studies, and RevMan 5.3 was used for data analysis in this meta-analysis. The registration ID of this current meta-analysis on PROSPERO is CRD42021238042.

Results

In total, five studies with 2485 patients were included in this meta-analysis. For the baseline information, no significant differences in age, sex, tumor location, or tumor T staging were noted. Regarding short-term outcomes, the cirrhotic group had more major complications (OR=5.15, 95% CI=1.62 to 16.37, p=0.005), a higher re-operation rate (OR=2.04, 95% CI=1.07 to 3.88, p=0.03), and a higher short-term mortality rate (OR=2.85, 95% CI=1.93 to 4.20, p<0.00001) than the non-cirrhotic group. However, no significant differences in minor complications (OR=1.54, 95% CI=0.78 to 3.02, p=0.21) or the rate of intensive care unit (ICU) admission (OR=0.76, 95% CI=0.10 to 5.99, p=0.80) were noted between the two groups. Moreover, the non-cirrhotic group exhibited a longer survival time than the cirrhotic group (HR=2.96, 95% CI=2.28 to 3.85, p<0.00001).

Conclusion

Preexisting LC was associated with an increased postoperative major complication rate, a higher rate of re-operation, a higher short-term mortality rate, and poor overall survival following CRC surgery.

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128. https://doi.org/10.1016/S0140-6736(12)61728-0.CrossRefPubMed

Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet. 2014;383(9930):1749–61. https://doi.org/10.1016/S0140-6736(14)60121-5.CrossRefPubMed

Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis. Hepatology. 2010;51(4):1445–9. https://doi.org/10.1002/hep.23478.CrossRefPubMed

Han EC, Ryoo SB, Park JW, Yi JW, Oh HK, Choe EK, et al. Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: a propensity-matched study. PLoS One. 2017;12(6):e0178920. https://doi.org/10.1371/journal.pone.0178920.CrossRefPubMedPubMedCentral

Lopez-Delgado JC, Ballus J, Esteve F, Betancur-Zambrano NL, Corral-Velez V, Mañez R, et al. Outcomes of abdominal surgery in patients with liver cirrhosis. World J Gastroenterol. 2016;22(9):2657–67. https://doi.org/10.3748/wjg.v22.i9.2657.CrossRefPubMedPubMedCentral

del Olmo JA, Flor-Lorente B, Flor-Civera B, Rodriguez F, Serra MA, Escudero A, et al. Risk factors for nonhepatic surgery in patients with cirrhosis. World J Surg. 2003;27(6):647–52. https://doi.org/10.1007/s00268-003-6794-1.CrossRefPubMed

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492.CrossRefPubMed

Kekelidze M, D'Errico L, Pansini M, Tyndall A, Hohmann J. Colorectal cancer: current imaging methods and future perspectives for the diagnosis, staging and therapeutic response evaluation. World J Gastroenterol. 2013;19(46):8502–14. https://doi.org/10.3748/wjg.v19.i46.8502.CrossRefPubMedPubMedCentral

Planellas P, Farrés R, Cornejo L, Rodríguez-Hermosa JI, Pigem A, Timoteo A, et al. Randomized clinical trial comparing side to end vs end to end techniques for colorectal anastomosis. Int J Surg. 2020;83:220–9. https://doi.org/10.1016/j.ijsu.2020.09.039.CrossRefPubMed

10.

Teresa G, Ugo P, Francesca G, et al. Colonic J-Pouch or straight colorectal reconstruction after low anterior resection for rectal cancer: impact on quality of life and bowel function: a multicenter prospective randomized study. Dis Colon Rectum. 2020;63(11):1511–23. https://doi.org/10.1097/DCR.0000000000001745.CrossRef

11.

Liao CK, Chern YJ, Lin YC, Hsu YJ, Chiang JM, Tsai WS, et al. Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study. World J Surg Oncol. 2021;19(1):6. https://doi.org/10.1186/s12957-020-02112-2.CrossRefPubMedPubMedCentral

12.

Lai IL, You JF, Chern YJ, Tsai WS, Chiang JM, Hsieh PS, et al. Survival analysis of local excision vs total mesorectal excision for middle and low rectal cancer in pT1/pT2 stage and intermediate pathological risk. World J Surg Oncol. 2019;17(1):212. https://doi.org/10.1186/s12957-019-1763-9.CrossRefPubMedPubMedCentral

13.

Troschel AS, Miks A, Troschel FM, Hüsing-Kabar A, Maschmeier M, Heinzow HS, et al. Chronic liver disease promotes lesions of the colorectal adenoma-carcinoma sequence, independent of liver cirrhosis. United European Gastroenterol J. 2019;7(5):662–72. https://doi.org/10.1177/2050640619826391.CrossRefPubMedPubMedCentral

14.

Sabbagh C, Chatelain D, Nguyen-Khac E, Rebibo L, Joly JP, Regimbeau JM. Management of colorectal cancer in patients with cirrhosis: a retrospective, case-matched study of short- and long-term outcomes. Dig Liver Dis. 2016;48(4):429–34. https://doi.org/10.1016/j.dld.2015.12.004.CrossRefPubMed

15.

Shin N, Han EC, Won S, Ryoo SB, Choe EK, Park BK, et al. The prognoses and postoperative outcomes of patients with both colorectal cancer and liver cirrhosis based on a nationwide cohort in Korea. Ann Surg Treat Res. 2020;99(2):82–9. https://doi.org/10.4174/astr.2020.99.2.82.CrossRefPubMedPubMedCentral

16.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647. https://doi.org/10.1136/bmj.g7647.CrossRefPubMed

17.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.CrossRefPubMedPubMedCentral

18.

Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8(1):16. https://doi.org/10.1186/1745-6215-8-16.CrossRefPubMedPubMedCentral

19.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5. https://doi.org/10.1007/s10654-010-9491-z.CrossRefPubMed

20.

Ioannidis JP. Interpretation of tests of heterogeneity and bias in meta-analysis. J Eval Clin Pract. 2008;14(5):951–7. https://doi.org/10.1111/j.1365-2753.2008.00986.x.CrossRefPubMed

21.

Lacatus M, Costin L, Bodean V, et al. The outcome of colorectal surgery in cirrhotic patients: a case match report. Chirurgia (Bucur). 2018; 113(2): 210- 217. doi: https://doi.org/10.21614/chirurgia.113.2.210.

22.

Montomoli J, Erichsen R, Christiansen CF, Ulrichsen SP, Pedersen L, Nilsson T, et al. Liver disease and 30-day mortality after colorectal cancer surgery: a Danish population-based cohort study. BMC Gastroenterol. 2013;13(1):66. https://doi.org/10.1186/1471-230X-13-66.CrossRefPubMedPubMedCentral

23.

Sturm L, Rössle M, Schultheiß M. Complications of liver cirrhosis - pharmaceutical versus interventional therapy. Dtsch Med Wochenschr. 2019;144(18):1259–66. https://doi.org/10.1055/a-0753-6051.CrossRefPubMed

24.

Chung W, Jo C, Chung WJ, Kim DJ. Liver cirrhosis and cancer: comparison of mortality. Hepatol Int. 2018;12(3):269–76. https://doi.org/10.1007/s12072-018-9850-5.CrossRefPubMed

25.

Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58(3):593–608. https://doi.org/10.1016/j.jhep.2012.12.005.CrossRefPubMed

26.

Garrison RN, Cryer HM, Howard DA, et al. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg. 1984;199(6):648–55. https://doi.org/10.1097/00000658-198406000-00003.CrossRefPubMedPubMedCentral

27.

Weiss A, Ward EP, Baumgartner JM, Lowy AM, Kelly KJ. Cirrhosis is not a contraindication to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in highly selected patients. World J Surg Oncol. 2018;16(1):87. https://doi.org/10.1186/s12957-018-1389-3.CrossRefPubMedPubMedCentral

28.

Telem DA, Schiano T, Goldstone R, et al. Factors that predict outcome of abdominal operations in patients with advanced cirrhosis. Clin Gastroenterol Hepatol. 2010;8(5):451–7, quiz e58. https://doi.org/10.1016/j.cgh.2009.12.015.CrossRefPubMed

29.

Wiklund RA. Preoperative preparation of patients with advanced liver disease. Crit Care Med. 2004;32(4 Suppl):S106–15. https://doi.org/10.1097/01.ccm.0000115624.13479.e6.CrossRefPubMed

30.

Malik SM, Ahmad J. Preoperative risk assessment for patients with liver disease. Med Clin North Am. 2009;93(4):917–29. https://doi.org/10.1016/j.mcna.2009.03.001.CrossRefPubMed

31.

Patel T. Surgery in the patient with liver disease. Mayo Clin Proc. 1999;74(6):593–9. https://doi.org/10.4065/74.6.593.CrossRefPubMed

32.

Lee JH, Yu CS, Lee JL, Kim CW, Yoon YS, Park IJ, et al. Factors affecting the postoperative morbidity and survival of patients with liver cirrhosis following colorectal cancer surgery. Int J Colorectal Dis. 2017;32(4):521–30. https://doi.org/10.1007/s00384-016-2739-7.CrossRefPubMed

33.

Meunier K, Mucci S, Quentin V, Azoulay R, Arnaud JP, Hamy A. Colorectal surgery in cirrhotic patients: assessment of operative morbidity and mortality. Dis Colon Rectum. 2008;51(8):1225–31. https://doi.org/10.1007/s10350-008-9336-y.CrossRefPubMed

34.

Metcalf AM, Dozois RR, Wolff BG, et al. The surgical risk of colectomy in patients with cirrhosis. Dis Colon Rectum. 1987;30(7):529–31. https://doi.org/10.1007/BF02554783.CrossRefPubMed

35.

O’Leary JG, Friedman LS. Predicting surgical risk in patients with cirrhosis: from art to science. Gastroenterology. 2007;132(4):1609–11. https://doi.org/10.1053/j.gastro.2007.03.016.CrossRefPubMed

36.

Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, di Bisceglie AM. The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome. Arch Surg. 2005;140(7):650–4; discussion 655. https://doi.org/10.1001/archsurg.140.7.650.CrossRefPubMed

Title: Does liver cirrhosis affect the surgical outcome of primary colorectal cancer surgery? A meta-analysis
Authors: Yu-Xi Cheng
Wei Tao
Hua Zhang
Dong Peng
Zheng-Qiang Wei
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Liver Cirrhosis
Colorectal Cancer
Colorectal Cancer
Published in: World Journal of Surgical Oncology / Issue 1/2021
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-021-02267-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does liver cirrhosis affect the surgical outcome of primary colorectal cancer surgery? A meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Skin autofluorescence as a novel predictor of acute kidney injury after liver resection

A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy

Potential role of chimeric genes in pathway-related gene co-expression modules

Early oral feeding is safe and useful after rectosigmoid resection with anastomosis during cytoreductive surgery for primary ovarian cancer

Clinical efficacy and safety of maintenance therapy for advanced non-small cell lung cancer: a retrospective real-world study

The disease sites of female genital cancers of BRCA1/2-associated hereditary breast and ovarian cancer: a retrospective study