Neoadjuvant therapy versus direct to surgery for T4 colon cancer: meta-analysis

Abstract

Background Despite persistently poor oncological outcomes, approaches to the management of T4 colonic cancer remain variable, with the role of neoadjuvant therapy unclear. The aim of this review was to compare oncological outcomes between direct-to-surgery and neoadjuvant therapy approaches to T4 colon cancer. Methods A librarian-led systematic search of MEDLINE, Embase, the Cochrane Library, Web of Science, and CINAHL up to 11 February 2020 was performed. Inclusion criteria were primary research articles comparing oncological outcomes between neoadjuvant therapies or direct to surgery for primary T4 colonic cancer. Based on PRISMA guidelines, screening and data abstraction were undertaken in duplicate. Quality assessment was carried out using Cochrane risk-of-bias tools. Random-effects models were used to pool effect estimates. This study compared pathological resection margins, postoperative morbidity, and oncological outcomes of cancer recurrence and overall survival. Results Four studies with a total of 43 063 patients met the inclusion criteria. Compared with direct to surgery, neoadjuvant therapy was associated with increased rates of margin-negative resection (odds ratio (OR) 2.60, 95 per cent c.i. 1.12 to 6.02; n = 15 487) and 5-year overall survival (pooled hazard ratio 1.42, 1.10 to 1.82, I2 = 0 per cent; n = 15 338). No difference was observed in rates of cancer recurrence (OR 0.42, 0.15 to 1.22; n = 131), 30-day minor (OR 1.12, 0.68 to 1.84; n = 15 488) or major (OR 0.62, 0.27 to 1.44; n = 15 488) morbidity, or rates of treatment-related adverse effects. Conclusion Compared with direct to surgery, neoadjuvant therapy improves margin-negative resection rates and overall survival.

Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience

“…It is unknown, however, whether NAC could downstage tumours sufficiently to avoid the potential morbidity of PD‐RC altogether. Furthermore, a recent meta‐analysis found previous trials of NAC were limited by a lack of randomization and heterogeneity in NAC regimens [ 29 ]. Therefore, patient selection and choice of NAC for locally advanced CRC prior to PD‐RC is an important area of future research.…”

Protocol: The role of defunctioning stoma prior to neoadjuvant therapy for locally advanced colonic and rectal cancer-A systematic review

“…For colonic cancer, the typical treatment is early surgical resection followed by adjuvant chemotherapy, while the role of neoadjuvant chemotherapy is a relatively new topic. In a recent meta-analysis published in 2021, neoadjuvant chemotherapy was found to be associated with a greater rate of margin negative resection rate and improved survival [ 30 ].…”

The safety and efficacy of neoadjuvant chemotherapy based on our resectability criteria for locally advanced perihilar cholangiocarcinoma

“…The dose intensity of chemotherapy must be superior to that of AC for NAC. Furthermore, NAC is commonly used in other carcinomas [22][23][24]. In pancreatic ductal adenocarcinoma in particular, NAC is widely used to downsize the tumour for curative resection in BR and LA status, and to diminish possible micrometastases in R status [25][26][27].…”