Systematic review and meta-analysis on outcomes of salvage therapy in patients with tumour recurrence during ‘watch and wait’ in rectal cancer.

On, J.; Shim, J.; Aly, E.H.

Abstract

The ‘watch and wait’ approach has recently emerged as an alternative approach for managing patients with complete clinical response in rectal cancer. However, less is understood whether the intervention is associated with a favourable outcome among patients who require salvage therapy following local recurrence. A comprehensive systematic search was performed using EMBASE, PubMed, MEDLINE, Journals@Ovid as well as hand searches; published between 2004 and 2018, to identify studies where outcomes of patients undergoing watch and wait were compared with conventional surgery. Study quality was assessed using the Newcastle–Ottawa assessment scale. The main outcome was relative risks for overall and disease specific mortality in salvage therapy. Nine eligible studies were included in the meta-analysis. Of 248 patients who followed the watch and wait strategy, 10.5% had salvage therapy for recurrent disease. No statistical heterogeneity was found in the results. The relative risk of overall mortality in the salvage therapy group was 2.42 (95% confidence interval 0.96–6.13) compared with the group who had conventional surgery, but this was not statistically significant (P > 0.05). The relative risk of disease specific mortality in salvage therapy was 2.63 (95% confidence interval 0.81–8.53). Our findings demonstrated that there was no significant difference in overall and disease specific mortality in patients who had salvage treatment following recurrence of disease in the watch and wait group compared with the standard treatment group. However, future research into the oncological safety of salvage treatment is needed.

Citation

ON, J., SHIM, J. and ALY, E.H. 2019. Systematic review and meta-analysis on outcomes of salvage therapy in patients with tumour recurrence during ‘watch and wait’ in rectal cancer. Annals of the Royal College of Surgeons of England [online], 101(7), pages 441-452. Available from: https://doi.org/10.1308/rcsann.2019.0018

• Journal Article Type: Review
• Acceptance Date: Jan 14, 2019
• Online Publication Date: Mar 11, 2019
• Publication Date: Sep 30, 2019
• Deposit Date: Feb 28, 2022
• Publicly Available Date: Feb 28, 2022
• Journal: Annals of The Royal College of Surgeons of England
• Print ISSN: 0035-8843
• Electronic ISSN: 1478-7083
• Publisher: Royal College of Surgeons of England
• Peer Reviewed: Peer Reviewed
• Volume: 101
• Issue: 7
• Pages: 441-452
• DOI: https://doi.org/10.1308/rcsann.2019.0018
• Keywords: Rectal cancer; Watch and wait; Non-operative management; Salvage treatment
• Public URL: https://rgu-repository.worktribe.com/output/1447234