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Does a long interval between neoadjuvant chemoradiotherapy and surgery benefit the clinical outcomes of locally advanced rectal cancer? A systematic review and meta analyses

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Abstract

Purpose

The study aims to systematically evaluate the clinical efficacy after 8 weeks (long interval, LI) between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer.

Methods

The PubMed database, EMBASE database, and the Cochrane Library (deadline: September 25, 2021) were searched to select clinical studies that compared two intervals between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer: after 8 weeks (long interval, LI) and within 8 weeks (short interval, SI). The included studies were screened and evaluated according to the inclusion and exclusion criteria, and meta-analysis was performed by RevMan 5.3 software.

Results

Eighteen studies were included, with 9070 cases in the LI group and 14,207 cases in the SI group. The analysis results showed that the pathologic complete response (PCR) rate in the LI group was higher than that in the SI group (P < 0.00001). There was no significant difference in the R0 resection rate (P = 0.85), anal preservation rate (P = 0.89), morbidity rate (P = 0.60), anastomotic leakage rate (P = 0.06), operation time (P = 0.58), local recurrence rate (P = 0.56), distant metastasis rate (P = 0.32), or overall survival (OS) rate (P = 0.17) between the two groups.

Conclusion

A longer interval between neoadjuvant chemoradiotherapy and surgery can improve the PCR rate; however, it has no significant impact on the clinical efficacy or long-term prognosis. Due to some limitations in the number and quality of the studies, these findings still need to be further verified by multicenter, large-sample high-quality RCTs in the future.

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Funding

This work was supported by the scientific research project of Sichuan Vocational College of Health and Rehabilitation (CWKY-2020Y-04).

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Authors and Affiliations

  1. Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China

    Miao Yu & Sheng Li

  2. Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China

    Deng-Chao Wang & Jian Wei

  3. Department of Pathology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China

    Li-Yan Huang

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  1. Miao Yu
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  2. Deng-Chao Wang
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  3. Sheng Li
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  4. Li-Yan Huang
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  5. Jian Wei
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Contributions

Miao Yu and Deng-Chao Wang designed the study. Sheng Li ran the search strategy. Li-Yan Huang collected the data. Deng-Chao Wang and Miao Yu re-checked the data. Sheng Li and Li-Yan Huang performed the analyses, and Deng-Chao Wang checked the analyses. Jian Wei and Sheng Li assessed the quality of the studies, and Deng-Chao Wang confirmed the quality. Miao Yu wrote the manuscript, and Deng-Chao Wang edited the manuscript. All listed authors reviewed and revised the manuscript.

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Correspondence to Deng-Chao Wang.

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Yu, M., Wang, DC., Li, S. et al. Does a long interval between neoadjuvant chemoradiotherapy and surgery benefit the clinical outcomes of locally advanced rectal cancer? A systematic review and meta analyses. Int J Colorectal Dis 37, 855–868 (2022). https://doi.org/10.1007/s00384-022-04122-w

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  • DOI: https://doi.org/10.1007/s00384-022-04122-w

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