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International Journal of Colorectal Disease

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01-01-2015 | Review

Oncological outcomes of local excision compared with radical surgery after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis

Authors: Irshad Shaikh, Alan Askari, Suzana Ourû, Janindra Warusavitarne, Thanos Athanasiou, Omar Faiz

Published in: International Journal of Colorectal Disease | Issue 1/2015

Abstract

Background

Low rectal cancer is conventionally managed with neoadjuvant chemoradiotherapy (CRT) followed by radical surgery (RS). In patients who refuse a stoma or are unfit for RS, an alternative approach may be the use of pre-op CRT and local excision (LE) where tumours are responsive. The aim of this systematic review is to determine whether differences exist in local recurrence (LR), overall survival (OS) and disease-free (DFS) survival between patients treated with CRT + LE and CRT + RS.

Methods

A literature search was performed using MEDLINE/PubMed/Ovid databases and Google Scholar between 1946 and 2013. Studies comparing outcome following LE and RS post-CRT were included. A pooled analysis was carried out using the Mantel-Haenszel statistical (random effects) model to identify differences in LR, OS and DFS between CRT + LE and CRT + RS.

Results

Eight studies were suitable for pooled analyses of LR whereas five and four studies were analysed for OS and DFS, respectively. When RS was used as the reference group, LR rate was higher in the LE group. However, this was non-significant (odds ratio (OR) 1.29, confidence interval (CI) 0.72–2.31, p = 0.40). Similarly, no difference was observed in 10-year OS (OR 0.96, CI 0.38–2.43, p = 0.93) or 5-year DFS (OR 1.04, CI 0.61–1.76, p = 0.89). There was evidence of publication bias in studies used for DFS. Subgroup analysis of above outcomes in T3/any N stage cancers showed no difference in LE versus RS.

Conclusion

In the current evidence synthesis, there was no statistical difference in the LR, OS and DFS rates observed between patients treated with LE and RS for rectal cancer post-CRT. LE post-CRT may represent a viable alternative to RS for some patients wishing to avoid RS. However, further randomised studies are required to confirm these results.

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Title: Oncological outcomes of local excision compared with radical surgery after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis
Authors: Irshad Shaikh
Alan Askari
Suzana Ourû
Janindra Warusavitarne
Thanos Athanasiou
Omar Faiz
Publication date: 01-01-2015
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 1/2015
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-014-2045-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oncological outcomes of local excision compared with radical surgery after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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