{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T21:30:31Z","timestamp":1782855031966,"version":"3.54.5"},"reference-count":77,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T00:00:00Z","timestamp":1560902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T00:00:00Z","timestamp":1560902400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T00:00:00Z","timestamp":1560902400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,8,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The current standard of care in locally advanced rectal cancer (LARC) is neoadjuvant long-course chemoradiotherapy (nCRT) followed by total mesorectal excision (TME). Surgery is conventionally performed approximately 6\u20138 weeks after nCRT. This study aimed to determine the effect on outcomes of extending this interval.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic search was performed for studies reporting oncological results that compared the classical interval (less than 8 weeks) from the end of nCRT to TME with a minimum 8-week interval in patients with LARC. The primary endpoint was the rate of pathological complete response (pCR). Secondary endpoints were recurrence-free survival, local recurrence and distant metastasis rates, R0 resection rates, completeness of TME, margin positivity, sphincter preservation, stoma formation, anastomotic leak and other complications. A meta-analysis was performed using the Mantel\u2013Haenszel method.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twenty-six publications, including four RCTs, with 25 445 patients were identified. A minimum 8-week interval was associated with increased odds of pCR (odds ratio (OR) 1\u00b741, 95 per cent c.i. 1\u00b730 to 1\u00b752; P &amp;lt; 0\u00b7001) and tumour downstaging (OR 1\u00b718, 1\u00b705 to 1\u00b732; P\u00a0=\u00a00\u00b7004). R0 resection rates, TME completeness, lymph node yield, sphincter preservation, stoma formation and complication rates were similar between the two groups. The increased rate of pCR translated to reduced distant metastasis (OR 0\u00b771, 0\u00b754 to 0\u00b793; P\u00a0=\u00a00\u00b701) and overall recurrence (OR 0\u00b776, 0\u00b758 to 0\u00b798; P\u00a0=\u00a00\u00b704), but not local recurrence (OR 0\u00b783, 0\u00b749 to 1\u00b742; P\u00a0=\u00a00\u00b750).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A minimum 8-week interval from the end of nCRT to TME increases pCR and downstaging rates, and improves recurrence-free survival without compromising surgical morbidity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.11220","type":"journal-article","created":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T12:58:26Z","timestamp":1560949106000},"page":"1298-1310","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":85,"title":["Meta-analysis of the effect of extending the interval after long-course chemoradiotherapy before surgery in locally advanced rectal cancer"],"prefix":"10.1093","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2609-0836","authenticated-orcid":false,"given":"\u00c9 J","family":"Ryan","sequence":"first","affiliation":[{"name":"Department of Surgery, Tallaght University Hospital , Dublin, Ireland"},{"name":"School of Medicine, University College Dublin , Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D P","family":"O'Sullivan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tallaght University Hospital , Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0757-6411","authenticated-orcid":false,"given":"M E","family":"Kelly","sequence":"additional","affiliation":[{"name":"Surgical Professorial Unit, St Vincent's University Hospital , Dublin, Ireland"},{"name":"School of Medicine, University College Dublin , Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Z","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tallaght University Hospital , Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P C","family":"Neary","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tallaght University Hospital , Dublin, Ireland"},{"name":"School of Medicine, Trinity College Dublin, University of Dublin , Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P R","family":"O'Connell","sequence":"additional","affiliation":[{"name":"Surgical Professorial Unit, St Vincent's University Hospital , Dublin, Ireland"},{"name":"School of Medicine, University College Dublin , Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D O","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tallaght University Hospital , Dublin, Ireland"},{"name":"School of Medicine, Trinity College Dublin, University of Dublin , Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D C","family":"Winter","sequence":"additional","affiliation":[{"name":"Surgical Professorial Unit, St Vincent's University Hospital , Dublin, Ireland"},{"name":"School of Medicine, University College Dublin , Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J M","family":"O'Riordan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tallaght University Hospital , Dublin, Ireland"},{"name":"School of Medicine, Trinity College Dublin, University of Dublin , Dublin, 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