title: Effect of Interval between Neoadjuvant Chemoradiotherapy and Surgery on Oncological Outcome for Rectal Cancer: A Systematic Review and Meta-Analysis.
abstract: Aim. To evaluate the influence of interval between neoadjuvant chemoradiotherapy (NCRT) and surgery on oncological outcome. Methods. A systematic search was conducted in PubMed, the Cochrane Library, and Embase databases for publications reporting oncological outcomes of patients following rectal cancer surgery performed at different NCRT-surgery intervals. Relative risk (RR) of pathological complete response (pCR) among different intervals was pooled. Results. Fifteen retrospective cohort studies representing 4431 patients met the inclusion criteria. There was a significantly increased rate of pCR in patients treated with surgery followed 7 or 8 weeks later (RR, 1.45; 95% CI, 1.18-1.78; and P < 0.01 and RR, 1.49; 95% CI, 1.15-1.92; and P = 0.002, resp.). There is no consistent evidence of improved local control or overall survival with longer or shorter intervals. Conclusion. Performing surgery 7-8 weeks after the end of NCRT results in the highest chance of achieving pCR. For candidates of abdominoperineal resection before NCRT, these data support implementation of prolonging the interval after NCRT to optimize the chances of pCR and perhaps add to the possibility of ultimate organ preservation.
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.
authors.forename: Xiao-Jie
authors.initials: XJ
authors.lastname: Wang
authors.affiliation: Oncology Department, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 360000, China.
authors.forename: Zheng-Rong
authors.initials: ZR
authors.lastname: Zheng
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.
authors.forename: Pan
authors.initials: P
authors.lastname: Chi
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.
authors.forename: Hui-Ming
authors.initials: HM
authors.lastname: Lin
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.
authors.forename: Xing-Rong
authors.initials: XR
authors.lastname: Lu
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang