A Meta Analysis Of Preoperative Chemoradiotherapy On The Recent Efficacy Of Surgery Of Locally Advanced Rectal Cancer

Background:Colorctal cancer is one of the most common malignant tumors of the gigestive system.The incidence of colorectal cancer is on the rise when human changes the lifestyle.Rectal cancer accounts for one thrid of all colorecatl cancers.We get the operation as the center of the comprehensive treatment of rectal cancer.Five percent to the percent of rectal cancer patients belong to locally advanced rectal cancer,10% of rectal cancers relapse after surgery,and only half of them are confined to locally recurrent rectal cancer.In the past two decades,preoperative chemoradiotherapy combined with radical surgery for locally advanced rectal cancer(T3-4 and / or N0-2)has become the standard treatment modality for rectal cancer with the announcement of the results of several large phase III clinical trials.Preoperative chemoradiotherapy compared with postoperative chemoradiotherapy has achieved similar survival rates,preoperative radiotherapy and chemotherapy in the local control is superior to postoperative radiotherapy and chemotherapy.It can improve R0 resection rate,reduce the risk of local recurrence,and may increase the complete pathology Remission rate and more sphincter preservinganal,preoperative radiotherapy can also avoid radiation enteritis.Preoperative chemoradiotherapy appears to increase postoperative complications of rectal cancer resection,but clinical trials have reported con fl icting results.So far,preoperative chemoradiotherapy has not reached a consensus conclusion on postoperative complications of rectal cancer.Objective:The objective of this meta-analysis was performed to assess the effects of Preoperative chemoradiotherapy on recent compplications after local advanced rectal cancer resection.The main study of preoperative radiotherapy and chemotherapy on postoperative anastomotic leakage,incision infection,bleeding,intestinal obstruction.To guide clinicians to preoperative radiotherapy and chemotherapy more standardized use of preoperative radiotherapy and chemotherapy on the immediate postoperative rectal cancer have a more profound understanding.Methods: PubMed,the Cochrane Library,CNKI,VIP,and Wanfang were searched from 1980 to December 2016.Methodlogical assessment of bias risk of the included studies has bee performed.The meta analysis of the included studies has been carried out.Te analysed endpoints were the anastomotic leak?Incision infection?Postoperative bleeding?intestinal obstruction.Results:According to the inclution criteria,Thirteen literatures were included,including Seven randomized controlled trials and six retrospective trials.3804 patients were included in the meta-analysis.1879 forming the group undergoing preoperative chemoradiotherapy versus 1925 patients undergoing without preoperative chemoradiotherapy.meta-analyses show that:(1)as for the anastomotic leakage,two groups shows no sigificant differences(OR 1.33,95% CI 0.88 – 1.44).(2)as for Incision,two groups shows sigificant differences(OR=1.57,95%CI:1.12-2.20,P=0.009).(3)as for Postoperative bleeding,two groups shows no sigificant differences(OR 1.00,95% CI 0.62–1.60,P=0.99).(4)as for intestinal obstruction,two groups shows no sigificant differences(OR 1.43,95% CI 0.69–2.97,P=0.34).Conclusion:There was no significant difference between preoperative chemordiotherapy and surgery alon in anastomotic fistula,postoperative bleeding,postoperative intestinal obstruction and direct surgery,and did not increase postoperative anastomotic fistula,postoperative bleeding,postoperative intestinal obstruction,While in the incidence of incision infection,the incidence of surgery alon has increased.However,due to the limited number and quality of studies included,theabove conclusion is further validated by randomized controlled trials requiring more high-quality,long-term follow-up.