Low to very low quality evidence suggested that the minimally invasive step-up approach resulted in fewer adverse events, serious adverse events, less organ failure, and lower costs compared to open necrosectomy. Very low quality evidence suggested that the endoscopic minimally invasive step-up approach resulted in fewer adverse events than the video-assisted minimally invasive step-up approach but increased the number of procedures required for treatment. There is currently no evidence to suggest that early open necrosectomy is superior or inferior to peritoneal lavage or delayed open necrosectomy. However, the CIs were wide and significant benefits or harms of different treatments cannot be ruled out. The TENSION trial currently underway in Netherlands is assessing the optimal way to perform the minimally invasive step-up approach (endoscopic drainage followed by endoscopic necrosectomy if necessary versus percutaneous drainage followed by video-assisted necrosectomy if necessary) and is assessing important clinical outcomes of interest for this review. Implications for further research on this topic will be determined after the results of this RCT are available.
recurrence free survival (median 15 vs. 17 months; p = 0.99) for a NLR < 2.5 as compared to an NLR 2.5. The same held true when using a NLR of 3.75 (75th quartile) and 5.The median pre-operative platelet count was 227x109/L with a median PLR of 140. There was no difference in either overall survival (median 42 vs. 38 months p = 0.44) or recurrence free survival (median 15 vs. 17 months; p = 0.47) for a PLR < 140 as compared to a PLR 140. This was also true for a PLR of 200 (75th quartile). Conclusions: In contrast to the published literature we were not able to confirm either NLR or PLR as predictors of either overall or recurrence free survival following resection of colorectal liver metastases. It is likely that immune cell function, particularly at the tissue level, is a far more important predictor of patient outcome.
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