Francesco Fiorica1, Marco Trovò2, Gabriele Anania3, Daniele Marcello3, Fabrizio Di Benedetto4, Marina Marzola3, Fabrizio D'Acapito5, Guglielmo Nasti6, Massimiliano Berretta7. 1. Gastrointestinal Cancer Unit, Departments of Radiation Oncology, Medical Oncology and Surgery, University Hospital Ferrara, Ferrara, Italy. francesco.fiorica@unife.it. 2. Department of Radiation Oncology, Udine General Hospital, Udine, Italy. 3. Gastrointestinal Cancer Unit, Departments of Radiation Oncology, Medical Oncology and Surgery, University Hospital Ferrara, Ferrara, Italy. 4. Department of Liver and Multivisceral Transplant Center, Liver Surgery, University Hospital Modena, Modena, Italy. 5. Department of Surgery and Advanced Oncological Therapies, State Hospital Forlì, Forlì, Italy. 6. Department of Abdominal Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale"-IRCCS, Naples, Italy. 7. Division of Medical Oncology A, National Cancer Institute, IRCCS, Aviano, PN, Italy.
Abstract
BACKGROUND: Locally advanced rectal cancer is usually treated with a preoperative approach with radiochemotherapy followed by surgery. Patients obtaining a pathologic complete response have a very favorable long-term prognosis. This study was intended to assess whether major surgery can reduce tumor recurrences and prolong survival of patients with a complete response after radiochemotherapy. METHODS: Computerized literature search was performed to identify relevant articles. Comparative studies reporting the outcomes of non-operative and operative management in patients after neoadjuvant treatment were reviewed. Data synthesis was performed using Review Manager 5.0 software. RESULTS: Twelve non-randomized comparative studies with a total of 1812 patients were suitable for analysis. There was no significant difference in overall survival at 3 and 5 years (odds ratio [OR] 1.31; 95% CI 0.64-2.69; p = 0.46 and 1.48; 95% CI 1.00-2.20; p = 0.50) and in disease-free survival at 3 and 5 years (odds ratio [OR] 1.20; 95% CI 0.68-2.14; p = 0.53 and 1.22; 95% CI 0.86-1.74; p = 0.26, respectively) between locally advanced rectal cancer patients treated with and without operative approach. CONCLUSIONS: Major surgery does not seem to improve prognosis in patients obtaining a complete response after radiochemotherapy. Clinical trials, using clear criteria to identify complete response patients, are needed to recommend non-operative approach.
BACKGROUND: Locally advanced rectal cancer is usually treated with a preoperative approach with radiochemotherapy followed by surgery. Patients obtaining a pathologic complete response have a very favorable long-term prognosis. This study was intended to assess whether major surgery can reduce tumor recurrences and prolong survival of patients with a complete response after radiochemotherapy. METHODS: Computerized literature search was performed to identify relevant articles. Comparative studies reporting the outcomes of non-operative and operative management in patients after neoadjuvant treatment were reviewed. Data synthesis was performed using Review Manager 5.0 software. RESULTS: Twelve non-randomized comparative studies with a total of 1812 patients were suitable for analysis. There was no significant difference in overall survival at 3 and 5 years (odds ratio [OR] 1.31; 95% CI 0.64-2.69; p = 0.46 and 1.48; 95% CI 1.00-2.20; p = 0.50) and in disease-free survival at 3 and 5 years (odds ratio [OR] 1.20; 95% CI 0.68-2.14; p = 0.53 and 1.22; 95% CI 0.86-1.74; p = 0.26, respectively) between locally advanced rectal cancerpatients treated with and without operative approach. CONCLUSIONS: Major surgery does not seem to improve prognosis in patients obtaining a complete response after radiochemotherapy. Clinical trials, using clear criteria to identify complete response patients, are needed to recommend non-operative approach.
Entities:
Keywords:
Conservative approach; Radiochemotherapy; Rectal cancer conservative approach
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