Outcomes after the watch-and-wait strategy and local excision treatment for rectal cancer: a meta-analysis

ABSTRACT

Background

The watch-and-wait (W&W) strategy and local excision (LE) have been used in patients with clinical complete response (cCR) for rectal cancer, but the comparative outcomes of the two strategies are controversial. We compared the efficacy of the W&W strategy with LE for rectal cancer patients after neoadjuvant chemoradiotherapy (nCRT) or total neoadjuvant therapy (TNT).

Research design and methods

Several domestic and foreign databases were searched for the relevant literature on comparative trials of the W&W strategy and LE surgery for rectal cancer after neoadjuvant therapy with the following outcomes; differences in local recurrence (LR), distant metastasis (DM/DM+LR), 3-year disease-free survival (DFS), 3-year local recurrence-free survival (LRFS) and 3-year overall survival (OS).

Results

Nine articles, were analyzed. Overall, 442 patients were included, with 267 and 175 patients in the W&W and LE groups, respectively. Meta-analysis results showed no significant differences the between W&W and LE groups with respect to LR, DM/DM+LR, 3-year DFS, 3-year LRFS, and 3-year OS. This study has been registered in PROSPERO (registration number: CRD42022331208).

Conclusion

The W&W strategy may be preferred for some rectal cancer patients who select LE and reach cCR or near cCR after nCRT or TNT.

KEYWORDS:

• Rectal cancer
• watch-and-wait
• local excision
• meta-analysis
• neoadjuvant chemoradiotherapy

Acknowledgments

We are grateful to Ganzhou Municipal Hospital of Ganann Medicine University, Ganzhou, China; Department of General Surgery, Guangdong Provincial People’s Hospital Ganzhou Hospital, Ganzhou Municipal Hospital, Ganzhou, China and Department of Gastrointestinal Surgery, Guangdong Provincial People’s Hospital, Guangzhou, China for providing technical support for our research. Thanks to our co-authors for their joint efforts. Thanks to the National Key Clinical Specialty Construction Project (2021–2024, No. 2022YW030009), the Leading Innovation Specialist Support Program of Guangdong Province, CSCO-Roche Cancer Research Foundation (No. Y-2019Roche-190), CSCO-Haosen Research Foundation (No. YHS2019/2-050), and the Science and Technology Planning Project of Ganzhou (No. 202101074816) for providing fund support.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

Jinghui Li and Xueqing Yao were involved in the conception and design. Jinghui Li, Yongli Ma and Liang Wen contributed to literature search, including and excluding literature, extracting data, analyzing data. Jinghui Li, Xueqing Yao and Guosheng Zhang participated in the drafting or revision of the paper. All authors agree to take responsibility for all aspects of this article.

Additional information

Funding

This work was funded by grants from the National Key Clinical Specialty Construction Project (2021–2024, No. 2022YW030009), the Leading Innovation Specialist Support Program of Guangdong Province, CSCO-Roche Cancer Research Foundation (No. Y-2019Roche-190), CSCO-Haosen Research Foundation (No. YHS2019/2-050), and the Science and Technology Planning Project of Ganzhou (No. 202101074816).