É J Ryan1,2, D P O'Sullivan1, M E Kelly3,2, A Z Syed1, P C Neary1,4, P R O'Connell3,2, D O Kavanagh1,4, D C Winter3,2, J M O'Riordan1,4. 1. Department of Surgery, Tallaght University Hospital, Dublin, Ireland. 2. School of Medicine, University College Dublin, Dublin, Ireland. 3. Surgical Professorial Unit, St Vincent's University Hospital, Dublin, Ireland. 4. School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland.
Abstract
BACKGROUND: The current standard of care in locally advanced rectal cancer (LARC) is neoadjuvant long-course chemoradiotherapy (nCRT) followed by total mesorectal excision (TME). Surgery is conventionally performed approximately 6-8 weeks after nCRT. This study aimed to determine the effect on outcomes of extending this interval. METHODS: A systematic search was performed for studies reporting oncological results that compared the classical interval (less than 8 weeks) from the end of nCRT to TME with a minimum 8-week interval in patients with LARC. The primary endpoint was the rate of pathological complete response (pCR). Secondary endpoints were recurrence-free survival, local recurrence and distant metastasis rates, R0 resection rates, completeness of TME, margin positivity, sphincter preservation, stoma formation, anastomotic leak and other complications. A meta-analysis was performed using the Mantel-Haenszel method. RESULTS: Twenty-six publications, including four RCTs, with 25 445 patients were identified. A minimum 8-week interval was associated with increased odds of pCR (odds ratio (OR) 1·41, 95 per cent c.i. 1·30 to 1·52; P < 0·001) and tumour downstaging (OR 1·18, 1·05 to 1·32; P = 0·004). R0 resection rates, TME completeness, lymph node yield, sphincter preservation, stoma formation and complication rates were similar between the two groups. The increased rate of pCR translated to reduced distant metastasis (OR 0·71, 0·54 to 0·93; P = 0·01) and overall recurrence (OR 0·76, 0·58 to 0·98; P = 0·04), but not local recurrence (OR 0·83, 0·49 to 1·42; P = 0·50). CONCLUSION: A minimum 8-week interval from the end of nCRT to TME increases pCR and downstaging rates, and improves recurrence-free survival without compromising surgical morbidity.
BACKGROUND: The current standard of care in locally advanced rectal cancer (LARC) is neoadjuvant long-course chemoradiotherapy (nCRT) followed by total mesorectal excision (TME). Surgery is conventionally performed approximately 6-8 weeks after nCRT. This study aimed to determine the effect on outcomes of extending this interval. METHODS: A systematic search was performed for studies reporting oncological results that compared the classical interval (less than 8 weeks) from the end of nCRT to TME with a minimum 8-week interval in patients with LARC. The primary endpoint was the rate of pathological complete response (pCR). Secondary endpoints were recurrence-free survival, local recurrence and distant metastasis rates, R0 resection rates, completeness of TME, margin positivity, sphincter preservation, stoma formation, anastomotic leak and other complications. A meta-analysis was performed using the Mantel-Haenszel method. RESULTS: Twenty-six publications, including four RCTs, with 25 445 patients were identified. A minimum 8-week interval was associated with increased odds of pCR (odds ratio (OR) 1·41, 95 per cent c.i. 1·30 to 1·52; P < 0·001) and tumour downstaging (OR 1·18, 1·05 to 1·32; P = 0·004). R0 resection rates, TME completeness, lymph node yield, sphincter preservation, stoma formation and complication rates were similar between the two groups. The increased rate of pCR translated to reduced distant metastasis (OR 0·71, 0·54 to 0·93; P = 0·01) and overall recurrence (OR 0·76, 0·58 to 0·98; P = 0·04), but not local recurrence (OR 0·83, 0·49 to 1·42; P = 0·50). CONCLUSION: A minimum 8-week interval from the end of nCRT to TME increases pCR and downstaging rates, and improves recurrence-free survival without compromising surgical morbidity.
Authors: Cristina Piva; Luca Panier Suffat; Edoardo T F Petrucci; Giovanna Manuguerra; Federico Vittone; Domenico Cante; Silvia Ferrario; Marina Paolini; Lorenzo Radici; Giorgio Vellani; Maria R La Porta Journal: Updates Surg Date: 2021-10-18
Authors: Maria C Riesco-Martinez; Carlos Fernandez-Martos; Cristina Gravalos-Castro; Paula Espinosa-Olarte; Anna La Salvia; Luis Robles-Diaz; Andrea Modrego-Sanchez; Rocio Garcia-Carbonero Journal: Cancers (Basel) Date: 2020-12-05 Impact factor: 6.639
Authors: H E Haak; G L Beets; K Peeters; P J Nelemans; V Valentini; C Rödel; L Kuo; F A Calvo; J Garcia-Aguilar; R Glynne-Jones; S Pucciarelli; J Suarez; G Theodoropoulos; S Biondo; D M J Lambregts; R G H Beets-Tan; M Maas Journal: Br J Surg Date: 2021-10-23 Impact factor: 11.122