Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Metaanalysis of Oncological and Operative Outcomes

Background Total neoadjuvant therapy in rectal cancer refers to the administration of chemoradiotherapy plus chemotherapy before surgery. Recent studies have shown improved pathological complete response and disease-free survival with this approach. However, survival benefits remain unproven. Our ob...

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Bibliographic Details
Published in:Annals of surgical oncology 2021-11, Vol.28 (12), p.7476-7486
Main Authors: Kong, Joseph C., Soucisse, Mikael, Michael, Michael, Tie, Jeanne, Ngan, Samuel Y., Leong, Trevor, McCormick, Jacob, Warrier, Satish K., Heriot, Alexander G.
Format: Article
Language:English
Subjects:
Anastomotic leak
Cancer
Cancer therapies
Chemoradiotherapy
Chemotherapy
Colorectal Cancer
Humans
Medicine
Medicine & Public Health
Neoadjuvant Therapy
Neoplasm Recurrence, Local - therapy
Neoplasm Staging
Oncology
Patients
Radiation therapy
Rectal Neoplasms - pathology
Rectal Neoplasms - therapy
Rectum
Rectum - pathology
Surgery
Surgical Oncology
Survival
Treatment Outcome
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Summary:Background Total neoadjuvant therapy in rectal cancer refers to the administration of chemoradiotherapy plus chemotherapy before surgery. Recent studies have shown improved pathological complete response and disease-free survival with this approach. However, survival benefits remain unproven. Our objective is to present a metaanalysis of oncological outcomes of total neoadjuvant therapy in locally advanced rectal cancer. Patients and Methods A comprehensive search was performed on PubMed, Medline, and Google Scholars. Studies comparing total neoadjuvant therapy with standard neoadjuvant chemoradiotherapy were included. Data extracted from the individual studies were pooled and a metaanalysis performed. The outcomes of interest are the rate of complete pathological response, nodal response, resection margin, anal preservation, anastomotic leak, local recurrence, distant recurrence, disease-free survival, and overall survival. Results There were 15 comparative studies with 2437 patients in the neoadjuvant chemoradiotherapy group and 2284 in the total neoadjuvant therapy group. The pooled complete pathological response was 22.3% in the total neoadjuvant therapy group, compared with 14.2% in the standard neoadjuvant chemoradiotherapy group ( p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-021-09837-8