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Efficacy and safety of the “watch-and-wait” approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a meta-analysis

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Abstract

Background

Watch-and-Wait (WW) approach is positioned at the cutting edge of non-invasive approach for rectal cancer patients who achieve clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT). This meta-analysis aimed to compare the clinical, oncologic, and survival outcomes of WW versus radical surgery (RS) and to evaluate the efficacy, safety, and possible superiority of WW.

Methods

A systematic search for studies comparing WW with RS was conducted on MEDLINE, Ovid, Embase, Cochrane Library, and Web of Science databases. After screening for inclusion, data extraction, and quality assessment, statistical analysis was performed using Stata/SE14.0 software. Permanent colostomy (PC), local recurrence (LR), distant metastasis (DM), cancer-related death (CRD), 2-, 3-, and 5-year disease-free survival (DFS), and overall survival (OS) were analyzed using fixed effects or random-effects models depending on the heterogeneity.

Results

Fourteen studies with moderate-high quality involving 1254 patients were included. Of these, 513 patients were managed with WW and 741 patients were subjected to RS. Compared to RS group, WW group had higher rate of LR (odds ratio OR = 11.09, 95% confidence interval CI = 5.30–23.20, P = 0.000), 2-year OS, and 3-year OS and had lower rate of PC (OR = 0.12, 95% CI = 0.05–0.29, P = 0.000). There were no significant between-group differences with respect to DM, CRD, 2-, 3-, and 5-year DFS (OR = 0.92, 95% CI = 0.81–1.03, P = 0.153), or 5-year OS (OR = 1.01, 95% CI = 0.28–3.63, P = 0.988).

Conclusion

The WW is a promising treatment approach and is a relatively safe alternative to RS for managing patients with rectal cancer who achieve cCR after nCRT. However, this modality requires rigorous screening criteria and standardized follow-up. Large-scale, multicenter prospective randomized controlled trials are warranted to further verify the outcomes of WW approach.

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Funding

This study was supported by the National Natural Science Foundation of China (82060542) and the Yunnan Provincial Science and Technology Department (008106293057), the Yunnan Education Department Project.

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Author notes

  1. Xuan Zhang and Rong Ding are Co-first authors.

Authors and Affiliations

  1. Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, No. 519, Kunzhou Road, Xishan District, 650118, Yunnan, Kunming, People’s Republic of China

    Xuan Zhang, JinSha Li, Tao Wu, Ting Li, GuoYu Li & YunFeng Li

  2. Department of Minimally Invasive Intervention, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan, Kunming, 650118, People’s Republic of China

    Rong Ding

  3. Office of Cancer Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118, People’s Republic of China

    ZhengHai Shen & Hai Zhou

  4. Department of Anesthesiology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan, Kunming, 650118, People’s Republic of China

    ShanShan Li

  5. Department of Orthopaedics, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan, Kunming, 650118, People’s Republic of China

    Ya Zhang

  6. Department of Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan, Kunming, 650118, People’s Republic of China

    Chao Dong

  7. Department of Hospital Affairs, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan, Kunming, 650118, People’s Republic of China

    ZhongJun Shang

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  1. Xuan Zhang
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Contributions

XZ, RD, and YFL contributed substantially to study design. XZ, JSL, GYL, and ZJS contributed to data extraction, quality assessment, and data analysis. XZ and SSL contributed to manuscript writing and edition. YZ, TW, and CD revised the manuscript for its integrity and accuracy. ZJS, TL, and HZ approved the final version of this manuscript and take responsibility for its content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to YunFeng Li.

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Xuan Zhang, Rong Ding, JinSha Li, Tao Wu, ZhengHai Shen, ShanShan Li, Ya Zhang, Chao Dong, ZhongJun Shang, Hai Zhou, Ting Li, GuoYu Li, and YunFeng Li have no conflict of interest or financial ties to disclose.

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Zhang, X., Ding, R., Li, J. et al. Efficacy and safety of the “watch-and-wait” approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a meta-analysis. Surg Endosc 36, 2233–2244 (2022). https://doi.org/10.1007/s00464-021-08932-x

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