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Comparing neoadjuvant therapy followed by local excision to total mesorectal excision in the treatment of early stage rectal cancer: a systematic review and meta-analysis of randomised clinical trials.
Lynch, Paul; Ryan, Odhrán K; Donnelly, Mark; Ryan, Éanna J; Davey, Matthew G; Reynolds, Ian S; Creavin, Ben; Hanly, Ann; Kennelly, Rory; Martin, Seán T; Winter, Des C.
Affiliation
  • Lynch P; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Ryan OK; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Donnelly M; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Ryan ÉJ; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. eannaryan@rcsi.com.
  • Davey MG; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Reynolds IS; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Creavin B; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Hanly A; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Kennelly R; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Martin ST; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
  • Winter DC; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Int J Colorectal Dis ; 38(1): 263, 2023 Nov 04.
Article in En | MEDLINE | ID: mdl-37924372
ABSTRACT

INTRODUCTION:

Total mesorectal excision (TME) is the standard-of-care in early, clinical stage (cT2-3 N0 M0) rectal cancer. Local excision (LE) may be an alternative after adequate response to neoadjuvant therapy (NAT), with either long-course chemoradiotherapy (nCRT) or short-course radiotherapy (SCRT), as a means of preserving the rectum and potentially obviating the morbidity of TME.

METHODS:

A systematic review was performed according to PRISMA guidelines for studies that randomly assigned patients with cT2-3 N0 M0 rectal cancer to either NAT + LE or TME that reported radiologic, oncologic, surgical, and morbidity outcomes.

RESULTS:

A total of 4 RCTs comprise 462 patients (232 patients receiving NAT + LE; nCRT n = 205; SCRT n = 27) and 230 undergoing TME, respectively. NAT compliance was 98.86%. The rate of early completion TME in the NAT + LE group was 22.3%, while the proportion of patients achieving durable organ preservation was 75.4% at mean follow-up of 5.6 years. There was no difference in disease-free survival (DFS) (HR [hazard ratio] 1.19; 95% CI 0.95, 1.49; p = 0.13) or overall survival (OS) (HR 0.94; 95% CI 0.72, 1.23; p = 0.63]) according to the assigned treatment arm. The local recurrence rate (LRR) (HR 1.22; 95% CI 0.5-3.02; p = 0.66) and distant metastases (HR 0.92; 95% CI 0.45, 1.90; p = 0.82) were also comparable between the groups. There was a significant reduction in major (OR 0.45; 95% CI 0.21, 0.95; p = 0.04) and minor morbidity (OR 0.45; 95% CI 0.24, 0.85; p = 0.01) for patients undergoing NAT + LE. Overall stoma formation was decreased in the NAT + LE group (OR 0.03; 95% CI 0.0, 0.23; p ≤ 0.00001).

CONCLUSION:

NAT + LE reduces adverse effects of TME, without any compromise in oncological outcomes, and the potential for an organ preserving strategy should be discussed with patients with T2-3N0 rectal cancers prior to treatment.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Rectal Neoplasms / Rectum Type of study: Systematic_reviews Limits: Humans Language: En Journal: Int J Colorectal Dis Journal subject: GASTROENTEROLOGIA Year: 2023 Document type: Article Affiliation country: Irlanda Publication country: ALEMANHA / ALEMANIA / DE / DEUSTCHLAND / GERMANY

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Rectal Neoplasms / Rectum Type of study: Systematic_reviews Limits: Humans Language: En Journal: Int J Colorectal Dis Journal subject: GASTROENTEROLOGIA Year: 2023 Document type: Article Affiliation country: Irlanda Publication country: ALEMANHA / ALEMANIA / DE / DEUSTCHLAND / GERMANY