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

被引：2

作者：

Lynch, Paul ^{[1
]}

Ryan, Odhran K. ^{[1
]}

Donnelly, Mark ^{[1
]}

Ryan, Eanna J. ^{[1
]}

Davey, Matthew G. ^{[1
]}

Reynolds, Ian S. ^{[1
]}

Creavin, Ben ^{[1
]}

Hanly, Ann ^{[1
]}

Kennelly, Rory ^{[1
]}

Martin, Sean T. ^{[1
]}

Winter, Des C. ^{[1
]}

机构：

[1] St Vincents Univ Hosp, Dept Colorectal Surg, Elm Pk, Dublin, Ireland

来源：

INTERNATIONAL JOURNAL OF COLORECTAL DISEASE | 2023年 / 38卷 / 01期

关键词：

Local excision; Neoadjuvant therapy; Organ preserving; Overall survival; Total mesorectal excision; TRANSANAL ENDOSCOPIC MICROSURGERY; PHASE-III TRIAL; ORGAN PRESERVATION; OPEN-LABEL; PREOPERATIVE CHEMORADIOTHERAPY; CHEMORADIATION THERAPY; INTERNATIONAL WATCH; COMPLETE RESPONSE; RADICAL SURGERY; TERM OUTCOMES;

D O I：

10.1007/s00384-023-04558-8

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

IntroductionTotal 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.MethodsA 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.ResultsA 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).ConclusionNAT + 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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页数：14