Background: Endovascular aneurysm repair (EVAR) has become the preferred strategy for elective repair of abdominal aortic aneurysm (AAA) for many patients. However, the superiority of the endovascular procedure has recently been challenged by reports of impaired long-term survival in patients who underwent EVAR. A systematic review of long-term survival following AAA repair was therefore undertaken.Methods: A systematic review was performed according to PRISMA guidelines. Articles reporting shortand/or long-term mortality of EVAR and open surgical repair (OSR) of AAA were identified. Pooled overall survival estimates (hazard ratios (HRs) with corresponding 95 per cent c.i. for EVAR versus OSR) were calculated using a random-effects model. Possible confounding owing to age differences between patients receiving EVAR or OSR was addressed by estimating relative survival.Results: Some 53 studies were identified. The 30-day mortality rate was lower for EVAR compared with OSR: 1⋅16 (95 per cent c.i. 0⋅92 to 1⋅39) versus 3⋅27 (2⋅71 to 3⋅83) per cent. Long-term survival rates were similar for EVAR versus OSR (HRs 1⋅01, 1⋅00 and 0⋅98 for 3, 5 and 10 years respectively; P = 0⋅721, P = 0⋅912 and P = 0⋅777). Correction of age inequality by means of relative survival analysis showed equal long-term survival: 0⋅94, 0⋅91 and 0⋅76 at 3, 5 and 10 years for EVAR, and 0⋅96, 0⋅91 and 0⋅76 respectively for OSR.Conclusion: Long-term overall survival rates were similar for EVAR and OSR. Available data do not allow extension beyond the 10-year survival window or analysis of specific subgroups. Literature search and inclusion criteriaA systematic review of the literature between 1991 and 2018 was undertaken according to PRISMA guidelines 6 . Studies were identified using PubMed, Embase, Web of Science and Cochrane databases. Eligible studies included patients with an intact AAA treated by either EVAR or OSR. Studies that did not compare Publication biasFunnel plots for 30-day and 5-year survival did not show considerable asymmetry (Fig. S2, supporting information).

Objective: Compare oncological long-term and short-term outcomes between patients with distal cT2N0 rectal cancer treated with chemoradiotherapy and local excision (CRT + LE) and patients treated with total mesorectal excision (TME). Summary Background Data: Previous studies showed that CRT + LE is equivalent to TME in local tumor control and survival for T2N0 rectal cancer. Methods: Seventy-nine patients with cT2N0 rectal adenocarcinoma treated with CRT + LE in the ACOSOG Z6041 trial were compared to a cohort of 79 patients with pT2N0 tumors treated with upfront TME in the Dutch TME trial. Survival, short-term outcomes, and health-related quality of life (HRQOL) were compared between groups. Results: Three patients (4%) in the CRT + LE group required abdominoperineal resection, compared with 31 (40%) in the TME group. Forty TME patients (51%) required a permanent stoma. CRT-related toxicity occurred in 43% of the CRT + LE patients; however, TME patients had a higher rate of complications requiring reoperation (1 vs 9%; P = 0.03). Five-year disease-free survival {88.2% [confidence interval (CI), 77.7%–93.9%] vs 88.3% [CI, 78.7%–93.7%]; P = 0.88} and overall survival [90.3% (CI, 80.8%–95.3%) vs 88.4% (CI, 78.9%–93.8%); P = 0.82] were similar in the 2 groups. Compared to baseline, overall HRQOL decreased in the CRT + LE group and improved in the TME group. In both groups, patients with sphincter preservation had worse HRQOL scores 1 year after surgery. Conclusions: In patients who underwent CRT + LE, oncological outcomes were similar to those of patients who underwent TME, with fewer complications requiring reoperation but significant CRT toxicity. Although overall HRQOL decreased in the CRT + LE group and improved in TME patients, when considering anorectal function, results were worse in both groups.