Prognosis And Safety Of Local Excision Strategies After Neoadjuvant Chemoradiotherapy For Rectal Cancer Patients With Clinical Complete Response: A Meta-analysis

Objective:The aim of this systematic review is to determine whether differences exist in local recurrence(LR),overall survival(OS)and disease-free(DFS)survival between patients achieved c CR after n CRT treated with LE and TME.Methods:A literature search was performed using Embase/Pub Med/The Cochrane Libraryand China national knowledge infrastructure between 2000 and 2020.Studies comparing outcome following rectal cancer achieved c CR after n CRT were divided into local excision group(LE)and TME surgery group(TME)were included.Revman 5.3 software tools was carried out using to identify differences in local recurrence(LR),distant metastasis(DM),cancer-related death(CRD),5 years disease free survival(DFS),5 years overall survival(OS)between local excision group(LE)and TME surgery group(TME)Results:nine studies were suitable for pooled analyses of this meta,and the quality of final included evaluation was all medium-to-high quality literatures.Six of them are english literature,three of them are Chinese.There were 1115 rectal cancer patients,284 in the LE group and 831 in the RS group.The results of the meta-analysis showed that the enterostomy rate of the TME surgery(TME)group was higher than local excision(LE)group(RR=0.22 95%,CI=0.06-0.75,P=0.02),and there was no significant difference in the local recurrence(LR),5-year disease-free survival rate(5-DFS),5-year survival rate(5-OSs),and tumor-related death(CRD)between the two groups.Conclusion:1.local excision strategy is feasible for some patients,so as to avoid serious complications after radical surgery,im a temporary or permanent colostomy,longer length of hospital stay and postoperative anal pain,keep organ function has great advantage,2.the enterostomy rate of the radical surgery(RS)group was higher than local excision(LE)group(RR=0.22 95%,CI=0.06-0.75,P=0.02),and there was no significant difference in the local recurrence(LR),5-year disease-free survival rate(5-DFS),5-year survival rate(5-OSs),and tumor-related death(CRD)between the two groups.