In locally-advanced rectal cancer (LARC), a minimum interval of eight weeks between the end of neoadjuvant long-course chemoradiotherapy (nCRT) and total mesorectal excision (TME) improves recurrence-free survival. That is the finding of new meta-analysis published in the British Journal of Surgery.
The study included 26 studies (n=25,445) reporting oncological results that compared the classical interval (<8 weeks) with a minimum eight-week interval in patients with LARC.
The longer interval was associated with increased odds of pathological complete response (odds ratio [OR] 1.41; 95% CI 1.30-1.52; P<0.001) and tumour downstaging (OR 1.18; 95% CI 1.05-1.32; P=0.004).
The increased rate of pathological complete response (pCR) translated to reduced distant metastasis (OR 0.71; 95% CI 0.54-0.93; P=0.01) and overall recurrence (OR 0.76; 95% CI 0.58-0.98; P=0.04), but not local recurrence (OR 0.83; 95% CI 0.49-1.42; P=0.50).
R0 resection rates, TME completeness, lymph node yield, sphincter preservation, stoma formation, and complication rates were similar between the two groups.
The authors concluded that intervals of eight weeks or more between the end of nCRT and TME increases pCR and downstaging rates, and improves recurrence-free survival without compromising surgical morbidity.
