Upfront Total Mesorectal Excision for MRI-Defined Low-Risk cT3 Rectal Cancer: A Systematic Review and Meta-Analysis.
Bernardo Fontel Pompeu, Camila Haddad Baptista, Thais Henriques Abud et al.
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In 30 seconds
This systematic review and meta-analysis compared upfront total mesorectal excision (TME) with neoadjuvant therapy for MRI-defined low-risk cT3 rectal cancer. Five studies involving 1447 patients were included. Upfront surgery was associated with shorter operative time (MD -25.7 min; 95% CI -38.6 to -12.7) and more lymph nodes retrieved (MD 6.6; 95% CI 6.0-7.3). Perioperative complications, recurrence, circumferential resection margin positivity, and survival did not differ significantly between strategies. Bayesian analyses were inconclusive, and the authors judged the evidence insufficient for definitive treatment recommendations.
Key findings
- Upfront TME was associated with shorter operative time (MD -25.7 min; 95% CI -38.6 to -12.7).
- Upfront surgery yielded more lymph nodes (MD 6.6; 95% CI 6.0-7.3).
- Local recurrence was similar between strategies (OR 0.99; 95% CI 0.58-1.70); disease-free and overall survival also showed no differences.
- No significant differences were observed in perioperative complications, including anastomotic leaks, intra-abdominal abscesses, or reoperations.
Why it matters
MRI-based risk stratification may identify patients for whom neoadjuvant therapy can potentially be avoided, but treatment comparisons need to account for both cancer control and operative outcomes. This review found broadly comparable reported oncologic outcomes, alongside some operative differences, while emphasizing that the evidence remains exploratory. The findings inform discussion of treatment strategies but do not establish equivalence.
What to keep in mind
The evidence came from five studies and was described by the authors as exploratory and insufficient for definitive recommendations; Bayesian analyses also indicated inconclusive evidence.