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Journal of Gastrointestinal Cancer

, Volume 50, Issue 1, pp 98–108 | Cite as

Is It Possible a Conservative Approach After Radiochemotherapy in Locally Advanced Rectal Cancer (LARC)? A Systematic Review of the Literature and Meta-analysis

  • Francesco FioricaEmail author
  • Marco Trovò
  • Gabriele Anania
  • Daniele Marcello
  • Fabrizio Di Benedetto
  • Marina Marzola
  • Fabrizio D’Acapito
  • Guglielmo Nasti
  • Massimiliano Berretta
Original Research

Abstract

Background

Locally advanced rectal cancer is usually treated with a preoperative approach with radiochemotherapy followed by surgery. Patients obtaining a pathologic complete response have a very favorable long-term prognosis. This study was intended to assess whether major surgery can reduce tumor recurrences and prolong survival of patients with a complete response after radiochemotherapy.

Methods

Computerized literature search was performed to identify relevant articles. Comparative studies reporting the outcomes of non-operative and operative management in patients after neoadjuvant treatment were reviewed. Data synthesis was performed using Review Manager 5.0 software.

Results

Twelve non-randomized comparative studies with a total of 1812 patients were suitable for analysis. There was no significant difference in overall survival at 3 and 5 years (odds ratio [OR] 1.31; 95% CI 0.64–2.69; p = 0.46 and 1.48; 95% CI 1.00–2.20; p = 0.50) and in disease-free survival at 3 and 5 years (odds ratio [OR] 1.20; 95% CI 0.68–2.14; p = 0.53 and 1.22; 95% CI 0.86–1.74; p = 0.26, respectively) between locally advanced rectal cancer patients treated with and without operative approach.

Conclusions

Major surgery does not seem to improve prognosis in patients obtaining a complete response after radiochemotherapy. Clinical trials, using clear criteria to identify complete response patients, are needed to recommend non-operative approach.

Keywords

Rectal cancer conservative approach Conservative approach Radiochemotherapy 

Notes

Acknowledgments

Programma di ricerca Regione-Università, Regione Emilia-Romagna, bando Giovani Ricercatori “Alessandro Liberati” 2012 supported the idea.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Francesco Fiorica
    • 1
    Email author
  • Marco Trovò
    • 2
  • Gabriele Anania
    • 1
  • Daniele Marcello
    • 1
  • Fabrizio Di Benedetto
    • 3
  • Marina Marzola
    • 1
  • Fabrizio D’Acapito
    • 4
  • Guglielmo Nasti
    • 5
  • Massimiliano Berretta
    • 6
  1. 1.Gastrointestinal Cancer Unit, Departments of Radiation Oncology, Medical Oncology and SurgeryUniversity Hospital FerraraFerraraItaly
  2. 2.Department of Radiation OncologyUdine General HospitalUdineItaly
  3. 3.Department of Liver and Multivisceral Transplant Center, Liver SurgeryUniversity Hospital ModenaModenaItaly
  4. 4.Department of Surgery and Advanced Oncological TherapiesState Hospital ForlìForlìItaly
  5. 5.Department of Abdominal Oncology, Istituto Nazionale per lo Studio e la Cura dei TumoriFondazione “G. Pascale”-IRCCSNaplesItaly
  6. 6.Division of Medical Oncology ANational Cancer Institute, IRCCSAvianoItaly

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