UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

The use of an evidence based approach to guide optimal surgical management of colorectal liver metastases

Simillis, C; (2016) The use of an evidence based approach to guide optimal surgical management of colorectal liver metastases. Doctoral thesis , UCL (University College London). Green open access

[thumbnail of MD Thesis.pdf]
Preview
Text
MD Thesis.pdf

Download (6MB) | Preview

Abstract

The aim of this thesis was to validate the optimal surgical management of colorectal liver metastases (CLM) by using an evidence based approach. A meta-analysis comparing combined and sequential resection for synchronous CLM demonstrated that combined resection is associated with reduced hospital stay and with comparable perioperative mortality and morbidity, operative blood loss, and survival rates as sequential resection. Nevertheless, combined resection was associated with lower metastatic disease severity compared to sequential resection. A meta-analysis assessed liver resection for CLM in the presence of hepatic lymph node involvement and demonstrated that survival rates are lower in node positive disease patients compared to node negative disease patients, irrespective of whether the positive disease nodes were detected by routine or selective lymphadenectomy, or whether nodal involvement was microscopic or macroscopic. A network meta-analysis comparing different treatment strategies aiming to decrease operative blood loss found no difference in mortality, length of hospital stay or ITU stay between the treatment strategies. The use of radiofrequency dissecting sealer resulted in more serious adverse events compared to the clamp-crush method in the absence of vascular occlusion and fibrin sealant. Simple methods, such as clamp-crush method, gave overall equivalent outcomes to methods which require special equipment. Not reporting the period of follow-up was investigated as a potential source of study bias. Overall analysis did not identify a significant difference in mortality and disease recurrence, but sensitivity analysis of more recent reviews and larger reviews showed that the trials reporting the period of follow-up had a significantly lower hazard ratio for disease recurrence compared to trials not reporting the period of follow-up. A network meta-analysis comparing interventions aiming to decrease ischaemia-reperfusion injury during liver resection, demonstrated that ischaemic preconditioning resulted in fewer serious adverse events, lower operative blood loss, fewer transfusion proportions, and shorter operative time.

Type: Thesis (Doctoral)
Title: The use of an evidence based approach to guide optimal surgical management of colorectal liver metastases
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Keywords: colorectal liver metastases, hepatectomy, evidence based approach, systematic review, meta-analysis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/1476960
Downloads since deposit
292Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item