Published online May 24, 2026. doi: 10.5306/wjco.v17.i5.118670
Revised: February 6, 2026
Accepted: March 18, 2026
Published online: May 24, 2026
Processing time: 132 Days and 19.1 Hours
Colorectal cancer is a major public health issue, with liver metastasis marking a critical and prognostically significant pathway for disease progression. This meta-analysis evaluated the association between surgical intervention for colorectal liver metastases and survival outcomes to inform multidisciplinary treatment decisions. We performed a thorough search of MEDLINE, EMBASE, and the Co
To provide an aggregate prognostic value for surgery for liver metastases, incorporating HRs with 95%CIs from multivariate or univariate analyses available in the included studies.
Sensitivity analysis was conducted even with meta-regression based on participant ethnicity (Asian vs non-Asian), number of patients, median follow-up, publication year (pre-2015 vs 2015-2024), paper quality (high vs low), and study design (retrospective vs prospective). Heterogeneity among studies was assessed using Cochran’s Q test, with P < 0.05 or I2 > 50% indicating significant heterogeneity, in which case a random-effects model (Der Simonian-Laird method) was applied. Otherwise, a fixed effects model was used. HR < 1 indicated improved survival in patients undergoing resection of liver metastases. Data were analyzed using the Review Manager (RevMan) software, version 5.4, The Cochrane Collaboration, 2020. Publication bias and small-study effects were assessed by visual inspection of funnel plots, Egger’s regression test, and rank-correlation testing; Duval and Tweedie’s trim-and-fill method was applied as a sensitivity analysis. Clinically, the attenuation of the pooled effect estimate after trim-and-fill adjustment suggests that the magnitude of survival benefit associated with surgery may be partially overestimated due to small-study effects or selective publication. However, the direction of the association remained consistent, supporting an association between surgical resection and improved survival in carefully selected patients.
Of the 2935 records identified, 67 studies with data from 368380 patients (ranging from 21 to 72376) were included in the meta-analysis. Most of the included studies (55 out of 67) were retrospective series, whereas 12 out of 67 were prospective (either clinical trials or prospective cohorts). The treatment strategies in the included studies consisted of upfront surgery followed by adjuvant therapy or preceded by neoadjuvant or conversion therapy (including three studies in which patients received hepatic artery infusion chemotherapy). Data regarding systemic therapies were unavailable for 17 studies. Data on the overall resection rate were available for 62 of the 67 studies. Resection rates ranged from 8% to 100% (median, 45%), whereas R0 resections ranged from 2% to 87% (median, 14%). The median follow-up period ranged from 4 months to 120 months (median, 37 months); however, it was not available in 42% of the papers.
Among the evaluable studies, the publication quality was classified as low (36%), moderate (46%), or high (18%). The association between surgery for colorectal liver metastases and survival outcomes is described in subsequent sections. Outcomes were analyzed using multivariate analysis in 90% of the cases.
Core Tip: The survival benefit of surgical resection for colorectal liver metastases has been debated, particularly in heterogeneous clinical settings. This systematic review and meta-analysis synthesizes available evidence and shows that surgery is associated with improved overall and progression-free survival compared with non-surgical approaches, although heterogeneity is substantial and most data are observational. Future studies should focus on defining predictive factors for benefit and identifying patient subgroups in whom alternative strategies may be more appropriate.