Systematic review and meta-analysis of follow-up after hepatectomy for colorectal liver metastases

Background: The evidence surrounding optimal follow-up after liver resection for colorectal metastases remains unclear. A significant proportion of recurrences occur in the early postoperative period, and some groups advocate more intensive review at this time. Methods: A systematic review of literature published between January 2003 and May 2010 was performed. Studies that described potentially curative primary resection of colorectal liver metastases that involved a defined follow-up protocol and long-term survival data were included. For meta-analysis, studies were grouped into intensive (more frequent review in the first 5 years after resection) and uniform (same throughout) follow-up. Results: Thirty-five studies were identified that met the inclusion criteria, involving 7330 patients. Only five specifically addressed follow-up. Patients undergoing intensive early follow-up had a median survival of 39.8 (95 per cent confidence interval 34.3 to 45.3) months with a 5-year overall survival rate of 41.9 (34.4 to 49.4) per cent. Patients undergoing routine follow-up had a median survival of 40.2 (33.4 to 47.0) months, with a 5-year overall survival rate of 38.4 (32.6 to 44.3) months. Conclusion: Evidence regarding follow-up after liver resection is poor. Meta-analysis failed to identify a survival advantage for intensive early follow-up.