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>The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol
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The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol
Liver resection (LR) in patients with liver metastasis from colorectal cancer remains the only curative treatment. Perioperative chemotherapy improves prognosis of these patients. However, there are concerns regarding the effect of preoperative chemotherapy on liver regeneration, which is a key event in avoiding liver failure after LR. The primary objective of this systematic review is to assess the effect of neoadjuvant chemotherapy on liver regeneration after (LR) or portal vein embolization (PVE) in patients with liver metastasis from colorectal cancer. The secondary objectives are to evaluate the impact of the type of chemotherapy, number of cycles, and time between end of treatment and procedure (LR or PVE) and to investigate whether there is an association between degree of hypertrophy and postoperative liver failure. This meta-analysis will include studies reporting liver regeneration rates in patients submitted to LR or PVE. Pubmed, Scopus, Web of Science, Embase, and Cochrane databases will be searched. Only studies comparing neoadjuvant vs no chemotherapy, or comparing chemotherapy characteristics (bevacizumab administration, number of cycles, and time from finishing chemotherapy until intervention), will be included. We will select studies from 1990 to present. Two researchers will individually screen the identified records, according to a list of inclusion and exclusion criteria. Primary outcome will be future liver remnant regeneration rate. Bias of the studies will be evaluated with the ROBINS-I tool, and quality of evidence for all outcomes will be determined with the GRADE system. The data will be registered in a predesigned database. If selected studies are sufficiently homogeneous, we will perform a meta-analysis of reported results. In the event of a substantial heterogeneity, a qualitative systematic review will be performed. The results of this systematic review may help to better identify the patients affected by liver metastasis that could present low regeneration rates after neoadjuvant chemotherapy. These patients are at risk to develop liver failure after extended hepatectomies and therefore are not good candidates for such aggressive procedures. PROSPERO registration number: CRD42020178481 (July 5, 2020).
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机译：肝脏切除（LR）患有结肠直肠癌的肝转移患者仍然是唯一的治疗方法。围手术期化疗提高了这些患者的预后。然而，有缺乏术前化疗对肝再生的影响，这是避免在LR后肝脏衰竭的关键事件。该系统审查的主要目标是评估Neoadjuvant化疗对肝转移患者的肝脏再生（LOR）或门静脉栓塞（PVE）的影响，从结肠直肠癌中患者。次要目标是评估化疗类型，循环次数和治疗结束（LR或PVE）之间的影响，并研究肥大和术后肝功能衰竭之间是否存在关联。该META分析将包括报告提交给LR或PVE的患者的肝再生率的研究。将搜索PubMed，Scopus，Scents，Embase和Cochrane数据库的PubMed。只有研究Neoadjuvant VS NO化疗，或比较化疗特征（Bevacizumab管理，循环次数，循环次数，以及从整理化疗直至干预的时间）。我们将从1990年选择学业。根据包含和排除标准的列表，两位研究人员将单独筛选已识别的记录。主要结果将是未来的肝残留的再生率。研究的偏见将通过Robins-I工具进行评估，并将与等级系统确定所有结果的证据质量。数据将在预先设计的数据库中注册。如果所选研究足够均匀，我们将对报告的结果进行荟萃分析。如果发生了实质性的异质性，将进行定性系统审查。该系统审查的结果可能有助于更好地识别受肝转移影响的患者，这些患者可能在Neoadjuvant化疗后呈现低再生率。这些患者面临延长肝切除术后患者发生肝脏衰竭，因此对这种激进程序并不是良好的候选人。 Prospero注册号：CRD42020178481（7月5日，2020年）。
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