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

J On, J Shim, EH Aly

Research output: Contribution to journalArticle

Abstract

Introduction 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. Materials and methods 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. Results 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). Conclusion 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.
Original languageEnglish
Pages (from-to)441-452
Number of pages12
JournalAnnals of the Royal College of Surgeons of England
Volume101
Issue number7
Early online date11 Mar 2019
DOIs
Publication statusPublished - Sep 2019

Fingerprint

Salvage Therapy
Rectal Neoplasms
Meta-Analysis
Recurrence
Neoplasms
Mortality
Confidence Intervals
PubMed
MEDLINE
Outcome Assessment (Health Care)
Safety

Keywords

  • rectal cancer
  • watch and wait
  • non-operative management
  • salvage treatment

Cite this

@article{2fb36466f6af459f873d0808da342167,
title = "Systematic review and meta-analysis on outcomes of salvage therapy in patients with tumour recurrence during ‘watch and wait’ in rectal cancer",
abstract = "Introduction 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. Materials and methods 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. Results 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). Conclusion 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.",
keywords = "rectal cancer, watch and wait, non-operative management, salvage treatment",
author = "J On and J Shim and EH Aly",
year = "2019",
month = "9",
doi = "10.1308/rcsann.2019.0018",
language = "English",
volume = "101",
pages = "441--452",
journal = "Annals of the Royal College of Surgeons of England",
issn = "0035-8843",
publisher = "Royal College of Surgeons of England",
number = "7",

}

TY - JOUR

T1 - Systematic review and meta-analysis on outcomes of salvage therapy in patients with tumour recurrence during ‘watch and wait’ in rectal cancer

AU - On, J

AU - Shim, J

AU - Aly, EH

PY - 2019/9

Y1 - 2019/9

N2 - Introduction 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. Materials and methods 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. Results 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). Conclusion 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.

AB - Introduction 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. Materials and methods 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. Results 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). Conclusion 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.

KW - rectal cancer

KW - watch and wait

KW - non-operative management

KW - salvage treatment

UR - http://www.mendeley.com/research/systematic-review-metaanalysis-outcomes-salvage-therapy-patients-tumour-recurrence-during-watch-wait

UR - https://abdn.pure.elsevier.com/en/en/researchoutput/systematic-review-and-metaanalysis-on-outcomes-of-salvage-therapy-in-patients-with-tumour-recurrence-during-watch-and-wait-in-rectal-cancer(2fb36466-f6af-459f-873d-0808da342167).html

UR - http://www.scopus.com/inward/record.url?scp=85071785002&partnerID=8YFLogxK

U2 - 10.1308/rcsann.2019.0018

DO - 10.1308/rcsann.2019.0018

M3 - Article

VL - 101

SP - 441

EP - 452

JO - Annals of the Royal College of Surgeons of England

JF - Annals of the Royal College of Surgeons of England

SN - 0035-8843

IS - 7

ER -