J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 8, August 2019, pages 572-582

Simultaneous, Delayed and Liver-First Hepatic Resections for Synchronous Colorectal Liver Metastases: A Systematic Review and Network Meta-Analysis

Figure 2. Predictive interval plot of the three surgical approaches. The blue line represents the line of no effect (OR: 1). The black and red lines denote confidence and predictive intervals, respectively. OR: odds ratio.

Figure 3. Rankograms of probability of each treatment being first, second, or third. The liver-first approach has an 86% probability of being the best, followed by the delayed and simultaneous approaches, with 8% and 5% probability, respectively. SUCRA: surface under the cumulative ranking area.

Figure 4. Node-split model (1 - 2): simultaneous vs. delayed; node-split model (1 - 3): simultaneous vs. liver-first; node-split model (2 - 3): delayed vs. liver-first. An agreement between direct and indirect evidence exists. The DIC demonstrates goodness of fit of the model. DIC: deviance information criterion.

**Table 1.** Included Studies, Patient Demographics and Characteristics, and Newcastle-Ottawa Scale (NOS) Score [17-48]
Author, year, study design, period, country	Number of patients (S/D/LF)	Gender (M), n (%) (S/D/LF)	Age (S/D/LF)	Colonic primaries (S/D/LF)	Major liver resection (S/D/LF)	NOS (max.: 9)
S: simultaneous; D: delayed; LF: liver-first; ns: non-significant; NR: not reported; NOS: Newcastle-Ottawa scale; RS: retrospective study.
Fukami et al [46], 2016, RS, 2006 - 2013, Japan	41/22/0	18 (44) 12 (55) P = 0.442	65 ± 9 65 ± 7 P = 0.755	25 (61) 10 (46) P = 0.291	9 (22) 7 (32) P = 0.091	8
Silberhumer et al [45], 2016, RS, 1984 - 2008, USA	320/109/0	176 (53) 68 (62) P = 0.10	59 ± 13 59 ± 12 P = 0.601	177 (55) 56 (51) P = 0.383	107 (33) 79 (73) P = 0.01	8
Tanaka et al [48], 2015, Japan	0/30/10	8 (27) 5 (50) P = 0.246	61 (37 - 80) 63 (39 - 74) P = 0.696	22 (73) 8 (80) P = 0.001	18 (61) 7 (70) P = 0.527	8
She et al [44], 2014, RS, 1990 - 2008, Hong Kong, China	28/88/0	22 (79) 59 (67) P = 0.25	65 (29 - 75) 59 (24 - 81) P = 0.06	15 (54) 69 (78) P = 0.01	12 (43) 54 (61) P = 0.09	8
Andres et al [47], 2012, Multicenter International	0/729/58	440 (60) 41 (71) P = 0.109	60 ± 11 59 ± 11 P = 0.710	558 (77) 25 (43) P < 0.001	NR	8
Patrono et al [43], 2014, RS, 1997 - 2012, Italy	46/60/0	24 (52) 37 (61) P = 0.33	64 ± 11 61 ± 9 P = 0.201	38 (83) 47 (78) P = 0.633	22 (48) 42 (70) P = 0.03	6
Abbott et al [42], 2012, RS, 1993 -2010, USA	60/84/0	40 (61) 49 (58) P = ns	57 (45 - 64) 54 (46 - 68) P = 0.163	26 (43) 31 (37) P = 0.441	20 (33) 63 (75) P = 0.001	7
Mayo et al [41], 2012, RS, 1982 - 2011, Multicenter International	329/647/28	185 (56) 396 (68) 17 (60) P = ns	60 ± 30 61 ± 18 58 ± 12 P > 0.05	238 (72) 475 (74) 13 (46) P = 0.007	78 (24) 250 (39) 10 (36) P < 0.001	8
Brouquet et al [40], 2010, RS, 1992 - 2009, USA	43/72/27	23 (53) 44 (61) 10 (37) P = ns	58 (31 - 77) 56 (25 - 81) 48 (25 - 78) P = 0.02	25 (58) 37 (51) 19 (70) P = 0.02	15 (35) 48 (66) 24 (89)	8
de Haas et al [39], 2010, RS, 1990 - 2006, France	55/173/0	28 (51) 107 (62) P = 0.914	56 58 P = 0.323	47 (85) 110 (64) P = 0.267	NR	8
Luo et al [38], 2010, RS, 1994 - 2008, China	129/276/0	76 (59) 156 (57) P = 0.650	58 60 P = 0.720	60 (47) 138 (50) P = 0.470	44 (34) 133 (48) P = 0.054	7
Kaibori et al [37], 2010, RS, 1993 - 2007, Japan	32/42/0	27 (53) 27 (64) P = 0.332	65 62 P = 0.233	17 (53) 9 (21) P = 0.084	10 (32) 9 (38) P = 0.90	9
Moug et al [36], 2010, RS, UK	32/32/0	18 (56) 21 (66) P = ns	69 67 P ≥ 0.05	17 (53) 17 (53) P = ns	7 (22) 7 (22) P = ns	8
Van der Pool et al [35], 2010, RS, 2000 - 2007, The Netherlands	8/29/20	NR	NR	All rectal	NR	6
Slupski et al [34], 2009, RS, 1997 - 2006, Poland	28/61/0	18 (64) 34 (56) P = 0.48	59 60 P = 0.710	NR	8 (28) 29 (48) P = 0.10	7
Martin et al [33], 2009, RS, 1997 - 2008, USA	70/160/0	38 (54) 83 (52) P = 0.7	58 61 P = 0.06	49 (70) 123 (77) P = ns	33 (47) 64 (40) P = ns	7
Petri et al [32], 2008, RS, 1999 - 2008, Hungary	14/29/0	8 (57) 17 (59) P = nr	60 64 P = nr	NR	0% 6 (29) P = 0.155	6
Yoshidome et al [31], 2008, RS, 1985 - 2006, Japan	116/21/0	71 (58) 12 (52) P = 0.914	NR	67 (58) 11 (52) P = 0.820	NR	6
Reddy et al [30], 2007, RS, 1985 - 2005, USA	135/474/0	84 (62) 275 (58) P = 0.47	57 58 P = 0.641	81 (60) 365 (77) P = 0.001	36 (27) 291 (61) P = 0.001	6
Thelen et al [29], 2007, RS, 1988 - 2005, Germany	40/179/0	24 (60) 96 (54) P = 0.465	60 60 P = 0.731	34 (85) 107 (60) P = 0.04	15 (38) 141 (79) P = 0.001	7
Yan et al [28], 2007, OCS, Australia	73/30/0	48 (47) 37 (45) P = 0.671	60 59 P = 0.821	58 (79) 18 (60) P = 0.05	54 (74) 22 (73) P = ns	8
Capussotti et al [27], 2007, RS, 1984 - 2004, Italy	70/57/0	40 (54) 35 (59) P = 0.710	65 60 P = 0.10	43 (61) 37 (65) P = 0.713	24 (34) 32 (56) P = 0.01	8
Turini et al [26], 2007, RS, 1996 - 2004, France	57/62/0	NR	60 59 P = 0.08	33 (58) 42 (68) P = 0.07	7 (25) 23 (29) P = ns	6
Vassiliou et al [25], 2007, RS, 1996 - 2004, Greece	25/78/0	15 (59) 47 (61) P = ns	63 61 P = ns	22 (88) 70 (89) P = ns	NR	8
Taniai et al [24], 2006, RS, 1990 - 2002, Japan	67/41/0	35 (52) 25 (61) P = 0.375	63 63 P = 0.628	25 (37) 14 (34) P = 0.733	NR	6
Minagawa et al [23], 2006, RS, 1980 - 2002, Japan	142/18/0	NR	NR	70 (49) 14 (78) P = 0.02	16 (11) 7 (38) P = 0.005	5
Chua et al [22], 2004, RS, 1996 - 1999, USA	64/32/0	39 (61) 18 (56) P = 0.7	63 61 P = 0.34	29 (46) 17 (54) P = 0.520	10 (16) 13 (40) P = 0.01	9
Tanaka et al [21], 2004, Japan	39/37/0	20 (51) 25 (68) P = ns	NR	25 (65) 20 (53)	5 (13) 22 (59) P < 0.01	7
Weber et al [20], 2000, RS, 1987 - 2000, France	35/62/0	18 (51) 31 (50) P = 0.89	58 60 P = 0.54	25 (71) 38 (61) P = 0.431	11 (31) 35 (56) P = 0.01	5
Jaeck et al [19], 1999, RS, France	28/31/0	NR	56 60 P = 0.70	22 (78) 19 (61) P = 0.170	11 (32) 17 (52) P = 0.11	7
Vogt et al [18], 1991, RS, 1977 - 1987, Germany	19/17/0	NR	NR	NR	6 (32) 9 (53) P = 0.521	5
Scheele et al [17], 1991, RS, 1960 - 1988, Germany	90/42/0	NR	NR	NR	NR	6
Pooled total, 6,202	2,235/3,824/143	P = ns	P = ns	61% 66% 59% P = 1.00	565 (30) 1,415 (53) 41 (29) P < 0.001	Higher quality 22

Table 1. Included Studies, Patient Demographics and Characteristics, and Newcastle-Ottawa Scale (NOS) Score [17-48]

Author, year, study design, period, country

Number of patients (S/D/LF)

Gender (M), n (%) (S/D/LF)

Age (S/D/LF)

Colonic primaries (S/D/LF)

Major liver resection (S/D/LF)

NOS (max.: 9)

S: simultaneous; D: delayed; LF: liver-first; ns: non-significant; NR: not reported; NOS: Newcastle-Ottawa scale; RS: retrospective study.

Fukami et al [46], 2016, RS, 2006 - 2013, Japan

41/22/0

18 (44)
12 (55)
P = 0.442

65 ± 9
65 ± 7
P = 0.755

25 (61)
10 (46)
P = 0.291

9 (22)
7 (32)
P = 0.091

Silberhumer et al [45], 2016, RS, 1984 - 2008, USA

320/109/0

176 (53)
68 (62)
P = 0.10

59 ± 13
59 ± 12
P = 0.601

177 (55)
56 (51)
P = 0.383

107 (33)
79 (73)
P = 0.01

Tanaka et al [48], 2015, Japan

0/30/10

8 (27)
5 (50)
P = 0.246

61 (37 - 80)
63 (39 - 74)
P = 0.696

22 (73)
8 (80)
P = 0.001

18 (61)
7 (70)
P = 0.527

She et al [44], 2014, RS, 1990 - 2008, Hong Kong, China

28/88/0

22 (79)
59 (67)
P = 0.25

65 (29 - 75)
59 (24 - 81)
P = 0.06

15 (54)
69 (78)
P = 0.01

12 (43)
54 (61)
P = 0.09

Andres et al [47], 2012, Multicenter International

0/729/58

440 (60)
41 (71)
P = 0.109

60 ± 11
59 ± 11
P = 0.710

558 (77)
25 (43)
P < 0.001

Patrono et al [43], 2014, RS, 1997 - 2012, Italy

46/60/0

24 (52)
37 (61)
P = 0.33

64 ± 11
61 ± 9
P = 0.201

38 (83)
47 (78)
P = 0.633

22 (48)
42 (70)
P = 0.03

Abbott et al [42], 2012, RS, 1993 -2010, USA

60/84/0

40 (61)
49 (58)
P = ns

57 (45 - 64)
54 (46 - 68)
P = 0.163

26 (43)
31 (37)
P = 0.441

20 (33)
63 (75)
P = 0.001

Mayo et al [41], 2012, RS, 1982 - 2011, Multicenter International

329/647/28

185 (56)
396 (68)
17 (60)
P = ns

60 ± 30
61 ± 18
58 ± 12
P > 0.05

238 (72)
475 (74)
13 (46)
P = 0.007

78 (24)
250 (39)
10 (36)
P < 0.001

Brouquet et al [40], 2010, RS, 1992 - 2009, USA

43/72/27

23 (53)
44 (61)
10 (37)
P = ns

58 (31 - 77)
56 (25 - 81)
48 (25 - 78)
P = 0.02

25 (58)
37 (51)
19 (70)
P = 0.02

15 (35)
48 (66)
24 (89)

de Haas et al [39], 2010, RS, 1990 - 2006, France

55/173/0

28 (51)
107 (62)
P = 0.914

56
58
P = 0.323

47 (85)
110 (64)
P = 0.267

Luo et al [38], 2010, RS, 1994 - 2008, China

129/276/0

76 (59)
156 (57)
P = 0.650

58
60
P = 0.720

60 (47)
138 (50)
P = 0.470

44 (34)
133 (48)
P = 0.054

Kaibori et al [37], 2010, RS, 1993 - 2007, Japan

32/42/0

27 (53)
27 (64)
P = 0.332

65
62
P = 0.233

17 (53)
9 (21)
P = 0.084

10 (32)
9 (38)
P = 0.90

Moug et al [36], 2010, RS, UK

32/32/0

18 (56)
21 (66)
P = ns

69
67
P ≥ 0.05

17 (53)
17 (53)
P = ns

7 (22)
7 (22)
P = ns

Van der Pool et al [35], 2010, RS, 2000 - 2007, The Netherlands

8/29/20

All rectal

Slupski et al [34], 2009, RS, 1997 - 2006, Poland

28/61/0

18 (64)
34 (56)
P = 0.48

59
60
P = 0.710

8 (28)
29 (48)
P = 0.10

Martin et al [33], 2009, RS, 1997 - 2008, USA

70/160/0

38 (54)
83 (52)
P = 0.7

58
61
P = 0.06

49 (70)
123 (77)
P = ns

33 (47)
64 (40)
P = ns

Petri et al [32], 2008, RS, 1999 - 2008, Hungary

14/29/0

8 (57)
17 (59)
P = nr

60
64
P = nr

0%
6 (29)
P = 0.155

Yoshidome et al [31], 2008, RS, 1985 - 2006, Japan

116/21/0

71 (58)
12 (52)
P = 0.914

67 (58)
11 (52)
P = 0.820

Reddy et al [30], 2007, RS, 1985 - 2005, USA

135/474/0

84 (62)
275 (58)
P = 0.47

57
58
P = 0.641

81 (60)
365 (77)
P = 0.001

36 (27)
291 (61)
P = 0.001

Thelen et al [29], 2007, RS, 1988 - 2005, Germany

40/179/0

24 (60)
96 (54)
P = 0.465

60
60
P = 0.731

34 (85)
107 (60)
P = 0.04

15 (38)
141 (79)
P = 0.001

Yan et al [28], 2007, OCS, Australia

73/30/0

48 (47)
37 (45)
P = 0.671

60
59
P = 0.821

58 (79)
18 (60)
P = 0.05

54 (74)
22 (73)
P = ns

Capussotti et al [27], 2007, RS, 1984 - 2004, Italy

70/57/0

40 (54)
35 (59)
P = 0.710

65
60
P = 0.10

43 (61)
37 (65)
P = 0.713

24 (34)
32 (56)
P = 0.01

Turini et al [26], 2007, RS, 1996 - 2004, France

57/62/0

60
59
P = 0.08

33 (58)
42 (68)
P = 0.07

7 (25)
23 (29)
P = ns

Vassiliou et al [25], 2007, RS, 1996 - 2004, Greece

25/78/0

15 (59)
47 (61)
P = ns

63
61
P = ns

22 (88)
70 (89)
P = ns

Taniai et al [24], 2006, RS, 1990 - 2002, Japan

67/41/0

35 (52)
25 (61)
P = 0.375

63
63
P = 0.628

25 (37)
14 (34)
P = 0.733

Minagawa et al [23], 2006, RS, 1980 - 2002, Japan

142/18/0

70 (49)
14 (78)
P = 0.02

16 (11)
7 (38)
P = 0.005

Chua et al [22], 2004, RS, 1996 - 1999, USA

64/32/0

39 (61)
18 (56)
P = 0.7

63
61
P = 0.34

29 (46)
17 (54)
P = 0.520

10 (16)
13 (40)
P = 0.01

Tanaka et al [21], 2004, Japan

39/37/0

20 (51)
25 (68)
P = ns

25 (65)
20 (53)

5 (13)
22 (59)
P < 0.01

Weber et al [20], 2000, RS, 1987 - 2000, France

35/62/0

18 (51)
31 (50)
P = 0.89

58
60
P = 0.54

25 (71)
38 (61)
P = 0.431

11 (31)
35 (56)
P = 0.01

Jaeck et al [19], 1999, RS, France

28/31/0

56
60
P = 0.70

22 (78)
19 (61)
P = 0.170

11 (32)
17 (52)
P = 0.11

Vogt et al [18], 1991, RS, 1977 - 1987, Germany

19/17/0

6 (32)
9 (53)
P = 0.521

Scheele et al [17], 1991, RS, 1960 - 1988, Germany

90/42/0

Pooled total, 6,202

2,235/3,824/143

P = ns

61%
66%
59%
P = 1.00

565 (30)
1,415 (53)
41 (29)
P < 0.001

Higher quality 22