Outcomes of Response-Based Watch-and-Wait and Surgical Management After Total Neoadjuvant Therapy for Rectal Cancer: A Systematic Review and Meta-analysis.
Bernardo Fontel Pompeu, Beatriz D'Andrea Pigossi, Luís Eduardo Braz de Moraes Alves et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the outcomes of response-based watch-and-wait (WW) versus surgical management (total mesorectal excision, TME) after total neoadjuvant therapy (TNT) for locally advanced rectal cancer. Analyzing six studies with 793 patients, the findings indicated that WW had comparable oncologic outcomes to TME, with a significant reduction in permanent stoma rates (OR 0.04, 95% CI 0.01-0.19).
Key findings
- No significant difference in local recurrence rates between WW and TME (OR 1.36, 95% CI 0.07-26.17).
- Distant metastases rates were similar for WW and TME (OR 0.62, 95% CI 0.29-1.33).
- 5-year disease-free survival rates were comparable (HR 0.97, 95% CI 0.71-1.31).
- Permanent stoma rates were significantly lower with WW after sensitivity analysis (OR 0.04, 95% CI 0.01-0.19).
Why it matters
Understanding the outcomes of WW versus TME after TNT is crucial for clinicians managing locally advanced rectal cancer, as it may influence treatment decisions and patient quality of life through organ preservation.