Tuesday, June 18, 2024

Comprehensive Review of Metachronous Metastases in Colorectal Cancer

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Understanding the occurrence of metachronous metastases (MM) in colorectal cancer (CRC) is crucial for improving patient outcomes. Although MM in CRC, colon cancer (CC), and rectal cancer (RC) have been studied, a systematic compilation of these findings has been lacking. This review aims to fill that gap by analyzing population-based studies to provide a clearer picture of MM incidence and trends.

Methodology and Study Selection

The researchers conducted an extensive search of MEDLINE, Embase, and the Cochrane Library for primary studies from their inception until January 2021, with an update in August 2023. The PRISMA guidelines were adhered to, and the Newcastle-Ottawa Quality Assessment Scale was employed to assess the risk of bias. The studies selected were scrutinized for outcomes concerning overall and organ-specific MM, followed by a narrative analysis to synthesize the findings.

Key Findings

From 2143 unique hits, 162 full-text publications were reviewed, and 37 population-based cohort studies published between 1981 and 2022 were included. Notably, ten studies utilized time-dependent analyses, eight were registry-based, and seven demonstrated a low risk of bias. Three studies revealed that the 5-year recurrence rates of MM for stages I-III were 20.5% for CRC, 18% and 25.6% for CC, and 23% for RC. Furthermore, four studies reported 5-year organ-specific MM recurrence rates, highlighting peritoneal and lung metastases in CRC and peritoneal metastases in CC. Twenty-seven studies provided data on the proportion of patients diagnosed with MM, albeit with varying follow-up lengths.

Valuable Inferences

Implications for Clinical Practice:

– There is evidence of a general decline in MM occurrences over time, suggesting improvements in treatment and early detection.
– The recurrence rate for organ-specific MM indicates the need for targeted surveillance and interventions.
– Variations in follow-up periods across studies highlight the necessity for standardized long-term monitoring protocols.

The studies with more sophisticated analyses showed considerable heterogeneity, whereas data from studies with less rigorous methodologies suggested a potential overall decline in MM incidence.

Original Article: World J Surg. 2024 May 15. doi: 10.1002/wjs.12204. Online ahead of print. PMID: 38747538 | DOI: 10.1002/wjs.12204

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