Efficacy and safety of the “watch-and-wait” approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a meta-analysis
Background Watch-and-Wait (WW) approach is positioned at the cutting edge of non-invasive approach for rectal cancer patients who achieve clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT). This meta-analysis aimed to compare the clinical, oncologic, and survival outcomes of...
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| Veröffentlicht in: | Surgical endoscopy 2022-04, Vol.36 (4), p.2233-2244 |
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| creator | Zhang, Xuan Ding, Rong Li, JinSha Wu, Tao Shen, ZhengHai Li, ShanShan Zhang, Ya Dong, Chao Shang, ZhongJun Zhou, Hai Li, Ting Li, GuoYu Li, YunFeng |
| description | Background
Watch-and-Wait (WW) approach is positioned at the cutting edge of non-invasive approach for rectal cancer patients who achieve clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT). This meta-analysis aimed to compare the clinical, oncologic, and survival outcomes of WW versus radical surgery (RS) and to evaluate the efficacy, safety, and possible superiority of WW.
Methods
A systematic search for studies comparing WW with RS was conducted on MEDLINE, Ovid, Embase, Cochrane Library, and Web of Science databases. After screening for inclusion, data extraction, and quality assessment, statistical analysis was performed using Stata/SE14.0 software. Permanent colostomy (PC), local recurrence (LR), distant metastasis (DM), cancer-related death (CRD), 2-, 3-, and 5-year disease-free survival (DFS), and overall survival (OS) were analyzed using fixed effects or random-effects models depending on the heterogeneity.
Results
Fourteen studies with moderate-high quality involving 1254 patients were included. Of these, 513 patients were managed with WW and 741 patients were subjected to RS. Compared to RS group, WW group had higher rate of LR (odds ratio
OR
= 11.09, 95% confidence interval
CI
= 5.30–23.20,
P
= 0.000), 2-year OS, and 3-year OS and had lower rate of PC (
OR
= 0.12, 95%
CI
= 0.05–0.29,
P
= 0.000). There were no significant between-group differences with respect to DM, CRD, 2-, 3-, and 5-year DFS (
OR
= 0.92, 95%
CI
= 0.81–1.03,
P
= 0.153), or 5-year OS (
OR
= 1.01, 95%
CI
= 0.28–3.63,
P
= 0.988).
Conclusion
The WW is a promising treatment approach and is a relatively safe alternative to RS for managing patients with rectal cancer who achieve cCR after nCRT. However, this modality requires rigorous screening criteria and standardized follow-up. Large-scale, multicenter prospective randomized controlled trials are warranted to further verify the outcomes of WW approach. |
| doi_str_mv | 10.1007/s00464-021-08932-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2616610630</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2638856636</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-4d24839136a2673ce0c2753aa44dd5849577601490f8d13af377a9352b4ffcdd3</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhS0EoreFF2CBLLHpJtR_cWJ2qCotUqVuYG1N_UNylcTBdrjNrg8C6rv1SXC5BSQWrMaa-eacsQ5Cryh5SwlpThIhQoqKMFqRVnFW3TxBGyrKgzHaPkUbojipWKPEATpMaUsKr2j9HB1woVrKON-guzPvewNmxTBZnMC7vOLgce4cvr_9voNsuqqMqh30-f72B4Z5jgFMh32IODqTYcAGJuMi3vW5w2bopyJYmmGcB5ddgdIcpuQw-FyoyQWw2-UbTBmbzo0hgu1D8Yswr-8w4NFlKJYwrKlPL9AzD0NyLx_rEfr84ezT6UV1eXX-8fT9ZWV4U-dKWCZariiXwGTDjSOGNTUHEMLauhWqbhpJqFDEt5Zy8LxpQPGaXQvvjbX8CB3vdcvvvi4uZT32ybhhgHLvkjSTVEpKJCcFffMPug1LLPc-ULxtaym5LBTbUyaGlKLzeo79CHHVlOiH-PQ-Pl3i07_i0zdl6fWj9HI9Ovtn5XdeBeB7IJXR9MXFv97_kf0J_RKp5w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2638856636</pqid></control><display><type>article</type><title>Efficacy and safety of the “watch-and-wait” approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a meta-analysis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Zhang, Xuan ; Ding, Rong ; Li, JinSha ; Wu, Tao ; Shen, ZhengHai ; Li, ShanShan ; Zhang, Ya ; Dong, Chao ; Shang, ZhongJun ; Zhou, Hai ; Li, Ting ; Li, GuoYu ; Li, YunFeng</creator><creatorcontrib>Zhang, Xuan ; Ding, Rong ; Li, JinSha ; Wu, Tao ; Shen, ZhengHai ; Li, ShanShan ; Zhang, Ya ; Dong, Chao ; Shang, ZhongJun ; Zhou, Hai ; Li, Ting ; Li, GuoYu ; Li, YunFeng</creatorcontrib><description>Background
Watch-and-Wait (WW) approach is positioned at the cutting edge of non-invasive approach for rectal cancer patients who achieve clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT). This meta-analysis aimed to compare the clinical, oncologic, and survival outcomes of WW versus radical surgery (RS) and to evaluate the efficacy, safety, and possible superiority of WW.
Methods
A systematic search for studies comparing WW with RS was conducted on MEDLINE, Ovid, Embase, Cochrane Library, and Web of Science databases. After screening for inclusion, data extraction, and quality assessment, statistical analysis was performed using Stata/SE14.0 software. Permanent colostomy (PC), local recurrence (LR), distant metastasis (DM), cancer-related death (CRD), 2-, 3-, and 5-year disease-free survival (DFS), and overall survival (OS) were analyzed using fixed effects or random-effects models depending on the heterogeneity.
Results
Fourteen studies with moderate-high quality involving 1254 patients were included. Of these, 513 patients were managed with WW and 741 patients were subjected to RS. Compared to RS group, WW group had higher rate of LR (odds ratio
OR
= 11.09, 95% confidence interval
CI
= 5.30–23.20,
P
= 0.000), 2-year OS, and 3-year OS and had lower rate of PC (
OR
= 0.12, 95%
CI
= 0.05–0.29,
P
= 0.000). There were no significant between-group differences with respect to DM, CRD, 2-, 3-, and 5-year DFS (
OR
= 0.92, 95%
CI
= 0.81–1.03,
P
= 0.153), or 5-year OS (
OR
= 1.01, 95%
CI
= 0.28–3.63,
P
= 0.988).
Conclusion
The WW is a promising treatment approach and is a relatively safe alternative to RS for managing patients with rectal cancer who achieve cCR after nCRT. However, this modality requires rigorous screening criteria and standardized follow-up. Large-scale, multicenter prospective randomized controlled trials are warranted to further verify the outcomes of WW approach.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-021-08932-x</identifier><identifier>PMID: 34981233</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Chemoradiotherapy ; Chemotherapy ; Colorectal cancer ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Humans ; Medicine ; Medicine & Public Health ; Meta-analysis ; Metastasis ; Neoadjuvant Therapy ; Ostomy ; Proctology ; Radiation therapy ; Rectal Neoplasms - pathology ; Rectal Neoplasms - therapy ; Review Article ; Surgery ; Surgical anastomosis ; Treatment Outcome ; Watchful Waiting</subject><ispartof>Surgical endoscopy, 2022-04, Vol.36 (4), p.2233-2244</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-4d24839136a2673ce0c2753aa44dd5849577601490f8d13af377a9352b4ffcdd3</citedby><cites>FETCH-LOGICAL-c375t-4d24839136a2673ce0c2753aa44dd5849577601490f8d13af377a9352b4ffcdd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-021-08932-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-021-08932-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34981233$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Xuan</creatorcontrib><creatorcontrib>Ding, Rong</creatorcontrib><creatorcontrib>Li, JinSha</creatorcontrib><creatorcontrib>Wu, Tao</creatorcontrib><creatorcontrib>Shen, ZhengHai</creatorcontrib><creatorcontrib>Li, ShanShan</creatorcontrib><creatorcontrib>Zhang, Ya</creatorcontrib><creatorcontrib>Dong, Chao</creatorcontrib><creatorcontrib>Shang, ZhongJun</creatorcontrib><creatorcontrib>Zhou, Hai</creatorcontrib><creatorcontrib>Li, Ting</creatorcontrib><creatorcontrib>Li, GuoYu</creatorcontrib><creatorcontrib>Li, YunFeng</creatorcontrib><title>Efficacy and safety of the “watch-and-wait” approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a meta-analysis</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Watch-and-Wait (WW) approach is positioned at the cutting edge of non-invasive approach for rectal cancer patients who achieve clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT). This meta-analysis aimed to compare the clinical, oncologic, and survival outcomes of WW versus radical surgery (RS) and to evaluate the efficacy, safety, and possible superiority of WW.
Methods
A systematic search for studies comparing WW with RS was conducted on MEDLINE, Ovid, Embase, Cochrane Library, and Web of Science databases. After screening for inclusion, data extraction, and quality assessment, statistical analysis was performed using Stata/SE14.0 software. Permanent colostomy (PC), local recurrence (LR), distant metastasis (DM), cancer-related death (CRD), 2-, 3-, and 5-year disease-free survival (DFS), and overall survival (OS) were analyzed using fixed effects or random-effects models depending on the heterogeneity.
Results
Fourteen studies with moderate-high quality involving 1254 patients were included. Of these, 513 patients were managed with WW and 741 patients were subjected to RS. Compared to RS group, WW group had higher rate of LR (odds ratio
OR
= 11.09, 95% confidence interval
CI
= 5.30–23.20,
P
= 0.000), 2-year OS, and 3-year OS and had lower rate of PC (
OR
= 0.12, 95%
CI
= 0.05–0.29,
P
= 0.000). There were no significant between-group differences with respect to DM, CRD, 2-, 3-, and 5-year DFS (
OR
= 0.92, 95%
CI
= 0.81–1.03,
P
= 0.153), or 5-year OS (
OR
= 1.01, 95%
CI
= 0.28–3.63,
P
= 0.988).
Conclusion
The WW is a promising treatment approach and is a relatively safe alternative to RS for managing patients with rectal cancer who achieve cCR after nCRT. However, this modality requires rigorous screening criteria and standardized follow-up. Large-scale, multicenter prospective randomized controlled trials are warranted to further verify the outcomes of WW approach.</description><subject>Abdominal Surgery</subject><subject>Chemoradiotherapy</subject><subject>Chemotherapy</subject><subject>Colorectal cancer</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Metastasis</subject><subject>Neoadjuvant Therapy</subject><subject>Ostomy</subject><subject>Proctology</subject><subject>Radiation therapy</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - therapy</subject><subject>Review Article</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><subject>Treatment Outcome</subject><subject>Watchful Waiting</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc1u1TAQhS0EoreFF2CBLLHpJtR_cWJ2qCotUqVuYG1N_UNylcTBdrjNrg8C6rv1SXC5BSQWrMaa-eacsQ5Cryh5SwlpThIhQoqKMFqRVnFW3TxBGyrKgzHaPkUbojipWKPEATpMaUsKr2j9HB1woVrKON-guzPvewNmxTBZnMC7vOLgce4cvr_9voNsuqqMqh30-f72B4Z5jgFMh32IODqTYcAGJuMi3vW5w2bopyJYmmGcB5ddgdIcpuQw-FyoyQWw2-UbTBmbzo0hgu1D8Yswr-8w4NFlKJYwrKlPL9AzD0NyLx_rEfr84ezT6UV1eXX-8fT9ZWV4U-dKWCZariiXwGTDjSOGNTUHEMLauhWqbhpJqFDEt5Zy8LxpQPGaXQvvjbX8CB3vdcvvvi4uZT32ybhhgHLvkjSTVEpKJCcFffMPug1LLPc-ULxtaym5LBTbUyaGlKLzeo79CHHVlOiH-PQ-Pl3i07_i0zdl6fWj9HI9Ovtn5XdeBeB7IJXR9MXFv97_kf0J_RKp5w</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Zhang, Xuan</creator><creator>Ding, Rong</creator><creator>Li, JinSha</creator><creator>Wu, Tao</creator><creator>Shen, ZhengHai</creator><creator>Li, ShanShan</creator><creator>Zhang, Ya</creator><creator>Dong, Chao</creator><creator>Shang, ZhongJun</creator><creator>Zhou, Hai</creator><creator>Li, Ting</creator><creator>Li, GuoYu</creator><creator>Li, YunFeng</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20220401</creationdate><title>Efficacy and safety of the “watch-and-wait” approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a meta-analysis</title><author>Zhang, Xuan ; Ding, Rong ; Li, JinSha ; Wu, Tao ; Shen, ZhengHai ; Li, ShanShan ; Zhang, Ya ; Dong, Chao ; Shang, ZhongJun ; Zhou, Hai ; Li, Ting ; Li, GuoYu ; Li, YunFeng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-4d24839136a2673ce0c2753aa44dd5849577601490f8d13af377a9352b4ffcdd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abdominal Surgery</topic><topic>Chemoradiotherapy</topic><topic>Chemotherapy</topic><topic>Colorectal cancer</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Metastasis</topic><topic>Neoadjuvant Therapy</topic><topic>Ostomy</topic><topic>Proctology</topic><topic>Radiation therapy</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - therapy</topic><topic>Review Article</topic><topic>Surgery</topic><topic>Surgical anastomosis</topic><topic>Treatment Outcome</topic><topic>Watchful Waiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Xuan</creatorcontrib><creatorcontrib>Ding, Rong</creatorcontrib><creatorcontrib>Li, JinSha</creatorcontrib><creatorcontrib>Wu, Tao</creatorcontrib><creatorcontrib>Shen, ZhengHai</creatorcontrib><creatorcontrib>Li, ShanShan</creatorcontrib><creatorcontrib>Zhang, Ya</creatorcontrib><creatorcontrib>Dong, Chao</creatorcontrib><creatorcontrib>Shang, ZhongJun</creatorcontrib><creatorcontrib>Zhou, Hai</creatorcontrib><creatorcontrib>Li, Ting</creatorcontrib><creatorcontrib>Li, GuoYu</creatorcontrib><creatorcontrib>Li, YunFeng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Xuan</au><au>Ding, Rong</au><au>Li, JinSha</au><au>Wu, Tao</au><au>Shen, ZhengHai</au><au>Li, ShanShan</au><au>Zhang, Ya</au><au>Dong, Chao</au><au>Shang, ZhongJun</au><au>Zhou, Hai</au><au>Li, Ting</au><au>Li, GuoYu</au><au>Li, YunFeng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy and safety of the “watch-and-wait” approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a meta-analysis</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>36</volume><issue>4</issue><spage>2233</spage><epage>2244</epage><pages>2233-2244</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Watch-and-Wait (WW) approach is positioned at the cutting edge of non-invasive approach for rectal cancer patients who achieve clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT). This meta-analysis aimed to compare the clinical, oncologic, and survival outcomes of WW versus radical surgery (RS) and to evaluate the efficacy, safety, and possible superiority of WW.
Methods
A systematic search for studies comparing WW with RS was conducted on MEDLINE, Ovid, Embase, Cochrane Library, and Web of Science databases. After screening for inclusion, data extraction, and quality assessment, statistical analysis was performed using Stata/SE14.0 software. Permanent colostomy (PC), local recurrence (LR), distant metastasis (DM), cancer-related death (CRD), 2-, 3-, and 5-year disease-free survival (DFS), and overall survival (OS) were analyzed using fixed effects or random-effects models depending on the heterogeneity.
Results
Fourteen studies with moderate-high quality involving 1254 patients were included. Of these, 513 patients were managed with WW and 741 patients were subjected to RS. Compared to RS group, WW group had higher rate of LR (odds ratio
OR
= 11.09, 95% confidence interval
CI
= 5.30–23.20,
P
= 0.000), 2-year OS, and 3-year OS and had lower rate of PC (
OR
= 0.12, 95%
CI
= 0.05–0.29,
P
= 0.000). There were no significant between-group differences with respect to DM, CRD, 2-, 3-, and 5-year DFS (
OR
= 0.92, 95%
CI
= 0.81–1.03,
P
= 0.153), or 5-year OS (
OR
= 1.01, 95%
CI
= 0.28–3.63,
P
= 0.988).
Conclusion
The WW is a promising treatment approach and is a relatively safe alternative to RS for managing patients with rectal cancer who achieve cCR after nCRT. However, this modality requires rigorous screening criteria and standardized follow-up. Large-scale, multicenter prospective randomized controlled trials are warranted to further verify the outcomes of WW approach.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>34981233</pmid><doi>10.1007/s00464-021-08932-x</doi><tpages>12</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Surgical endoscopy, 2022-04, Vol.36 (4), p.2233-2244 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Chemoradiotherapy Chemotherapy Colorectal cancer Endoscopy Gastroenterology Gynecology Hepatology Hospitals Humans Medicine Medicine & Public Health Meta-analysis Metastasis Neoadjuvant Therapy Ostomy Proctology Radiation therapy Rectal Neoplasms - pathology Rectal Neoplasms - therapy Review Article Surgery Surgical anastomosis Treatment Outcome Watchful Waiting |
| title | Efficacy and safety of the “watch-and-wait” approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a meta-analysis |
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