Efficacy and safety of wait and see strategy versus surgery for rectal cancer with cCR/near-cCR response after neoadjuvant chemoradiotherapy: a meta-analysis

Abstract

Background: To evaluate the efficacy and safety between wait and see strategy (WS) and surgery of rectal cancer patients with cCR/near-cCR response after neoadjuvant chemoradiotherapy.Methods: We searched PubMed, Cochrane Library, CNKI(China National Knowledge Infrastructure) and Wanfang databases to compare wait and see strategy with surgery for rectal cancer with cCR/near-cCR response after neoadjuvant chemoradiotherapy up to January 2020. We collected the data of local recurrence, distant metastasis, cancer related death, overall survival and diseasr-free survival and compared the advantages and disadvantages of the two groups.Results: 14 English studies with 3932 patients were included. There were 700 patients in WS group and 3232 patients in surgical group. WS group had higher local recurrence rate than surgery group(OR:3.55, 95% CI :2.35 to 5.36, P<0.001). WS group had better 2-year DFS(OR:0.74, 95% CI :0.56 to 0.96, P=0.03) and 2-year OS (OR:0.38, 95% CI :0.28 to 0.52, P<0.001) than surgery group. Subgroup analysis of WS group and radical surgery group also obtained the similar results. Eastern studies also supported the conclusion. There was no significant difference of other data between the two groups.Conslusion: Compared with surgery group, WS group would increase the risk of local recurrence rate, but WS group had better 2-year DFS and OS than surgery group. However, WS group did not increase the possibility of distant metastasis and cancer related death of the patients.