1). More colectomy combined with minor hepatectomy was performed in the simultaneous group. In addition, No study described adequately the patient flow. Methods for handling missing data were not adequately described in most studies. As shown by Supporting Fig. 2, the funnel plots are symmetrical, similar to inverted funnels, which means little publication bias exists in this meta-analysis for primary measures. To evaluate the long-term oncological outcomes of simultaneous and delayed hepatic resections for treating SCRLM, HRs of overall survival and recurrence-free survival were calculated and combined in the present study using the data extracted from Kaplan-Meier
curves (Fig. 2). Supporting Fig. 3 displays the constructed DAPT molecular weight version of overall survival Kaplan-Meier graphs based on data inputted to an HR Calculations Spreadsheet, 10 studies with a total of 1,190 patients were included, and the postoperative duration for overall survival analysis ranged from 36 months to 168 months. The final pooled estimate of overall survival showed similar outcomes for both simultaneous
and delayed resections (HR: 0.96; 95% CI: 0.81-1.14; P = 0.64; I2 = 0). When considering the effects of tumor recurrence on postoperative survival, analysis for the 486 patients from the four studies selleckchem also did not detect a significant difference for the two surgical treatment strategies, and the final pooled HR of recurrence-free survival was found to be 1.04 (95% CI:
0.76-1.43; P = 0.79; I2 = 53%), with the follow-up time ranging from 18 months to 120 months (Supporting Fig. 4). Meta-analyses for the efficacy (postoperative survival) and safety (postoperative complication and mortality) of the two hepatic resection strategies were the primary parameters in the current study. As mentioned above, simultaneous resection seemed endowed with a comparable long-term surgical oncological efficacy to delayed resection, whereas for safety considerations, a summary parameter of the two strategies implied a lower incidence of postoperative complication in the simultaneous group than that in the delayed group (modified RR = 0.77; 95% CI: 0.67-0.89; P = 0.0002; I2 = 10%) as shown by Fig. 3. In terms of postoperative mortality, significant PD184352 (CI-1040) difference was not observed based on the data included (RR = 1.12; 95% CI: 0.61-2.08; P = 0.71; I2 = 32%). Additionally, preoperative patient conditions in the simultaneous resection group were less severe, which were thought unavoidable in these observational studies due to the lack of randomized controlled trials (RCTs) so far. Nevertheless, distributions for various postoperative complications have been detailed and categorized in the present study (Supporting Table 2; Supporting Figs. 5, 6), and a conclusion could be drawn that simultaneous resection is safe for patients of SCRLM under some selected conditions.