Abstract
Objective Neoadjuvant radiotherapy (nRT) is an important treatment approach for rectal cancer. The relationship, however, between nRT and postoperative complications is still controversial. Here, we conducted a meta-analysis to evaluate such concerns. Methods The electronic literature from 1983 to 2021 was searched in PubMed, Embase, and Web of Science. Postoperative complications after nRT were included in the meta-analysis. The pooled odds ratio (OR) was calculated by the random-effects model. Statistical analysis was conducted by Review Manager 5.3 and STATA 14. Results A total of 23,723 patients from 49 studies were included in the meta-analysis. The pooled results showed that nRT increased the risk of anastomotic leakage (AL) compared to upfront surgery (OR = 1.23; 95% CI, 1.07–1.41; p=0.004). Subgroup analysis suggested that both long-course (OR = 1.20, 95% CI 1.03–1.40; p=0.02) and short-course radiotherapy (OR = 1.25, 95% CI, 1.02–1.53; p=0.04) increased the incidence of AL. In addition, nRT was the main risk factor for wound infection and pelvic abscess. The pooled data in randomized controlled trials, however, indicated that nRT was not associated with AL (OR = 1.01; 95% CI 0.82–1.26; p=0.91). Conclusions nRT may increase the risk of AL, wound infection, and pelvic abscess compared to upfront surgery among patients with rectal cancer.
Highlights
Colorectal cancer (CRC) is a common malignant tumor globally that is ranked third in terms of incidence and second in terms of mortality
Studies have shown that preoperative chemoradiotherapy downstages the primary tumor, increases the possibility of radical resection, increases the sphincter-preserving rate, and reduces the risk of local recurrence of rectal cancer [4,5,6,7]. erefore, total mesorectal excision (TME) after neoadjuvant chemoradiotherapy has become the standard treatment for locally advanced rectal cancer
After neoadjuvant chemoradiotherapy (nCRT) or total neoadjuvant therapy (TNT), approximately 15–30% of rectal cancer patients can achieve pathological complete response (PCR), which significantly improves the oncological outcome of patients [8,9,10]
Summary
Colorectal cancer (CRC) is a common malignant tumor globally that is ranked third in terms of incidence and second in terms of mortality. Some studies have reported that chemoradiotherapy may create local rectal tissue injury and influence anastomosis healing It remains controversial whether preoperative chemoradiotherapy leads to an increase in complications after rectal cancer surgery [22,23,24]. We conducted the present meta-analysis to explore whether nRT increases the risk of postoperative complications for rectal cancer. E exclusion criteria were as follows: (1) reviews, letters, expert opinions, comments, case reports, and metaanalysis; (2) incomplete data (no primary outcome or detailed data of postoperative complications) or no full text; (3) nonhuman studies; and (4) nonrelevant literature. E collection information was as follows: (1) first author name, journal name, publication time, nation, and the number of participants; (2) basic characteristics and therapy process of rectal cancer patients; and (3) postoperative complications (AL, wound infection, pelvic abscess, urinary tract infection, ileus, hemorrhage, reoperation, and overall complications) and mortality. We performed a subgroup analysis of RCT and non-RCT studies
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