Abstract
BackgroundSome clinical researchers have reported that patients with cCR (clinical complete response) status after neoadjuvant chemoradiotherapy (nCRT) could adopt the watch-and-wait (W&W) strategy. Compared with total mesorectal excision (TME) surgery, the W&W strategy could achieve a similar overall survival. Could the W&W strategy replace TME surgery as the main treatment option for the cCR patients? By using the meta-analysis method, we evaluated the safety and efficacy of the W&W strategy and TME surgery for rectal cancer exhibiting cCR after nCRT.MethodsWe evaluated two treatment strategies for rectal cancer with cCR after nCRT up to July 2021 by searching the Cochrane Library, PubMed, Wanfang, and China National Knowledge Infrastructure (CNKI) databases. Clinical data for primary outcomes (local recurrence, cancer-related death and distant metastasis), and secondary outcomes (disease-free survival (DFS) and overall survival (OS)) were collected to evaluate the efficacy and safety in the two groups.ResultsWe included nine studies with 818 patients in the meta-analysis, and there were five moderate-quality studies and four high-quality studies. A total of 339 patients were in the W&W group and 479 patients were in the TME group. The local recurrence rate in the W&W group was greater than that in the TME group in the fixed-effects model (OR 8.54, 95% CI 3.52 to 20.71, P < 0.001). The results of other outcomes were similar in the two groups.ConclusionThe local recurrence rate of the W&W group was greater than that in the TME group, but other results were similar in the two groups. With the help of physical examination and salvage therapy, the W&W strategy could achieve similar treatment effects with the TME approach.Trial registrationProtocol registration number: CRD42021244032.
Highlights
Some clinical researchers have reported that patients with clinical complete response (cCR) status after neoadjuvant chemoradiotherapy could adopt the watch-and-wait (W&W) strategy
The results indicated that the W&W group exhibited a higher local recurrence rate than the total mesorectal excision (TME) group, but the overall survival was similar in the two groups [13, 14]
A total of 339 patients were in the W&W group, and 479 patients were in the TME group
Summary
Some clinical researchers have reported that patients with cCR (clinical complete response) status after neoadjuvant chemoradiotherapy (nCRT) could adopt the watch-and-wait (W&W) strategy. Could the W&W strategy replace TME surgery as the main treatment option for the cCR patients? By using the meta-analysis method, we evaluated the safety and efficacy of the W&W strategy and TME surgery for rectal cancer exhibiting cCR after nCRT. NCRT can reduce the local recurrence and tumor size in patients with locally advanced rectal cancer [4]. It can increase the chance of preserving the anus by shrinking and downgrading tumors [5]. Multiple colorectal cancer guidelines recommend TME after nCRT as the standard treatment for locally advanced rectal cancer, but TME surgery has various complications, such as bleeding, intestinal obstruction, anastomotic leakage, and other complications [6]. TME could have a longterm negative impact on the defecation control and sexual functions [7, 8]
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