Feasibility Of Watch And Wait Treatment Strategies For Rectal Cancer Patients With Clinical Complete Response After Neoadjuvant Chemoradiotherapy:A Meta-analysis

Objective:By compare the oncological outcomes between Watch and Wait and surgery with clinical complete response after neoadjuvant chemoradiotherapy with meta-analysis to demonstrate the feasibility of the Watch and Wait strategyMethods:The clinical trials about Wait-and-See treatment strategies versus operation were comprehensively search on PubMed,Embase,the Cochrane Library datebase.According to the established inclusion criteria and exclusion criteria and the Newcastle-Ottawa quality assessment scale,the literature screening was carried out.The Watch and Wait Group was defined as observation group and Surgery group as Control group.Local recurrence,distant metastasis,cancer-related death,2 and 5 years disease-free survival and overall survival were the main outcomes and the dates were analyzed by Stata 12.0 software.Results:1.Total 9 eligible trials were included to compare the oncologic outcomes of rectal cancer patients achieving a cCR through Wait-and-See treatment approach(263 patientes)with the patients trough radical surgery(354 patients).2.Meta-analysis showed that the rate of local recurrence was higher in observation group than surgery group(RR=5.050;95%CI:2.215-11.513;P<0.001).3.There were no significant difference about distant metastasis among two groups(RR=0.928;95%CI:0.514-1.677;P=0.805).4.On obvious difference about cancer-related death was shown between observation and surgery groupes(RR=0.833;95%CI:0.372-1.868;P=0.658)5.Meta-analysis demonstrated that between observation and surgery groupes no difference ware found about 2-year DFS(RR=0.969,95%CI:0.915-1.026;P=0.277);2-yearOS(RR=1.033,95%CI:0.966-1.105;P=0.346);5-yearDFS(RR=0.946,95%CI:0.831-1.078;P=0.406);5-year OS(RR=1.026,95%CI:0.946-1.114;P=0.534).Conclusion:For the partial patients who achieved cCR after neoadjuvant chemoradiotherapy,the Watch and wait treatment strategy was feasible.But this treatment strategy need to be make rigorous screening criteria,standardized follow-up.It is necessary to take TME for the local recurrence patientes and the transanal wide excision and transanal endoscopic microsurgery were also recommended according to the patients.Additionally the Multi-center,large sample prospective randomized controlled trials were warranted to evaluate this treatment option.