{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T19:30:42Z","timestamp":1793820642026,"version":"4.6.1"},"reference-count":42,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007316","name":"National Cancer Institute Division of Cancer Prevention","doi-asserted-by":"publisher","award":["T32 CA009621"],"award-info":[{"award-number":["T32 CA009621"]}],"id":[{"id":"10.13039\/100007316","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007338","name":"Foundation for Barnes-Jewish Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007338","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011912","name":"School of Medicine, Washington University in St. Louis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011912","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journalofsurgicalresearch.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Research"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.jss.2026.07.011","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:51:11Z","timestamp":1786359071000},"page":"639-646","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Neoadjuvant Radiation Versus Upfront Surgery for Upper Rectal Cancer: A Systematic Review and Meta-Analysis of the Evidence"],"prefix":"10.1016","volume":"326","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5056-9105","authenticated-orcid":false,"given":"Ahmed A.","family":"Eltahir","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluseye K.","family":"Oduyale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram","family":"Pothuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Doering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine N.","family":"Zivanov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Cowan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerri A.","family":"Ohman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E.","family":"Wise","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Hunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew G.","family":"Mutch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Silviera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"William C.","family":"Chapman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jss.2026.07.011_bib1","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0140-6736(09)60484-0","article-title":"Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial","volume":"373","author":"Sebag-Montefiore","year":"2009","journal-title":"Lancet"},{"key":"10.1016\/j.jss.2026.07.011_bib2","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/S1470-2045(11)70097-3","article-title":"Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial","volume":"12","author":"van Gijn","year":"2011","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib3","doi-asserted-by":"crossref","first-page":"4850","DOI":"10.3748\/wjg.v25.i33.4850","article-title":"Neoadjuvant radiotherapy for rectal cancer management","volume":"25","author":"Feeney","year":"2019","journal-title":"World J Gastroenterol"},{"key":"10.1016\/j.jss.2026.07.011_bib4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/DCR.0b013e3181973a91","article-title":"A study into external rectal anatomy: improving patient selection for radiotherapy for rectal cancer","volume":"52","author":"Memon","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"10.1016\/j.jss.2026.07.011_bib5","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.6004\/jnccn.2022.0051","article-title":"Rectal cancer, version 2.2022, NCCN Clinical Practice Guidelines in oncology","volume":"20","author":"Benson","year":"2022","journal-title":"J Natl Compr Canc Netw"},{"key":"10.1016\/j.jss.2026.07.011_bib6","doi-asserted-by":"crossref","first-page":"iv22","DOI":"10.1093\/annonc\/mdx224","article-title":"Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Glynne-Jones","year":"2017","journal-title":"Ann Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib7","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1016\/j.ejso.2021.05.011","article-title":"A systematic review and meta-analysis comparing surgical and oncological outcomes of upper rectal, rectosigmoid and sigmoid tumours","volume":"47","author":"Morarasu","year":"2021","journal-title":"Eur J Surg Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib8","doi-asserted-by":"crossref","first-page":"5238","DOI":"10.1245\/s10434-021-09795-1","article-title":"Neoadjuvant short-course radiotherapy for upper third rectal tumors: systematic review and individual patient data metaanalysis of randomized controlled trials","volume":"28","author":"Flanagan","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib9","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1001\/jama.2015.3656","article-title":"Preferred reporting items for a systematic review and meta-analysis of individual participant data: the PRISMA-IPD statement","volume":"313","author":"Stewart","year":"2015","journal-title":"JAMA"},{"key":"10.1016\/j.jss.2026.07.011_bib10","first-page":"1","article-title":"The multimodal management of locally advanced rectal cancer: making sense of the new data","volume":"42","author":"Zwart","year":"2022","journal-title":"Am Soc Clin Oncol Educ Book"},{"key":"10.1016\/j.jss.2026.07.011_bib11","doi-asserted-by":"crossref","DOI":"10.3389\/fnut.2022.863059","article-title":"Association between wine consumption and cognitive decline in older people: a systematic review and meta-analysis of longitudinal studies","volume":"9","author":"Lucer\u00f3n-Lucas-Torres","year":"2022","journal-title":"Front Nutr"},{"key":"10.1016\/j.jss.2026.07.011_bib12","doi-asserted-by":"crossref","first-page":"415","DOI":"10.5271\/sjweh.3958","article-title":"Safety incidents associated with extended working hours. A systematic review and meta-analysis","volume":"47","author":"Matre","year":"2021","journal-title":"Scand J Work Environ Health"},{"key":"10.1016\/j.jss.2026.07.011_bib13","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1111\/codi.14918","article-title":"Neoadjuvant chemoradiation versus adjuvant chemotherapy for locally advanced adenocarcinoma of the rectosigmoid junction","volume":"22","author":"Salami","year":"2020","journal-title":"Colorectal Dis"},{"key":"10.1016\/j.jss.2026.07.011_bib14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0197-2456(95)00134-4","article-title":"Assessing the quality of reports of randomized clinical trials: is blinding necessary?","volume":"17","author":"Jadad","year":"1996","journal-title":"Control Clin Trials"},{"key":"10.1016\/j.jss.2026.07.011_bib15","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2016014","article-title":"A suggestion for quality assessment in systematic reviews of observational studies in nutritional epidemiology","volume":"38","author":"Bae","year":"2016","journal-title":"Epidemiol Health"},{"key":"10.1016\/j.jss.2026.07.011_bib33","article-title":"Neoadjuvant radiotherapy vs up-front surgery for resectable locally advanced rectal cancer","volume":"8","author":"Chen","year":"2025","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.jss.2026.07.011_bib16","doi-asserted-by":"crossref","first-page":"5644","DOI":"10.1200\/JCO.2005.08.144","article-title":"Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate","volume":"23","author":"Folkesson","year":"2005","journal-title":"JCO"},{"key":"10.1016\/j.jss.2026.07.011_bib34","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1177\/00031348251371207","article-title":"Neoadjuvant chemoradiation does not improve outcomes for patients undergoing resection for upper rectal cancer: A US Rectal Cancer Consortium Analysis","volume":"92","author":"Goel","year":"2026","journal-title":"Am Surg"},{"key":"10.1016\/j.jss.2026.07.011_bib35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.sopen.2021.06.002","article-title":"Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer","volume":"5","author":"Guidolin","year":"2021","journal-title":"Surg Open Sci"},{"issue":"28","key":"10.1016\/j.jss.2026.07.011_bib36","doi-asserted-by":"crossref","first-page":"3667","DOI":"10.1080\/14796694.2025.2582211","article-title":"Is neoadjuvant chemoradiotherapy necessary for locally advanced rectal cancer above the anterior peritoneal reflection?","volume":"21","author":"He","year":"2025","journal-title":"Future Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib37","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/COC.0000000000000931","article-title":"Rectosigmoid cancer\u2014rectal cancer or sigmoid cancer?","volume":"45","author":"Hui","year":"2022","journal-title":"Am J Clin Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib38","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/DCR.0000000000000349","article-title":"Selective approach for upper rectal cancer treatment: total mesorectal excision and preoperative chemoradiation are seldom necessary","volume":"58","author":"Marinello","year":"2015","journal-title":"Dis Colon Rectum"},{"key":"10.1016\/j.jss.2026.07.011_bib39","doi-asserted-by":"crossref","first-page":"6877","DOI":"10.21873\/anticanres.13063","article-title":"A matched-pair study comparing surgery plus neoadjuvant radio-chemotherapy and surgery alone for high rectal cancers","volume":"38","author":"Rades","year":"2018","journal-title":"Anticancer Res"},{"key":"10.1016\/j.jss.2026.07.011_bib40","doi-asserted-by":"crossref","first-page":"3579","DOI":"10.21873\/anticanres.14348","article-title":"Neoadjuvant treatment in upper rectal cancer does not improve oncologic outcomes but increases postoperative morbidity","volume":"40","author":"Tabchouri","year":"2020","journal-title":"Anticancer Res"},{"key":"10.1016\/j.jss.2026.07.011_bib41","doi-asserted-by":"crossref","DOI":"10.1007\/s13304-023-01744-9","article-title":"Comparative analysis of preoperative chemoradiotherapy and upfront surgery in the treatment of upper-half rectal cancer: oncological benefits, surgical outcomes, and cost implications","author":"Wang","year":"2024","journal-title":"Updates Surg"},{"key":"10.1016\/j.jss.2026.07.011_bib42","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.ejso.2017.04.007","article-title":"Is neoadjuvant chemoradiotherapy always necessary for mid\/high local advanced rectal cancer: A comparative analysis after propensity score matching","volume":"43","author":"Zhang","year":"2017","journal-title":"Eur J Surg Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib17","first-page":"19","article-title":"The investigation of primary rectal cancer by surgeons: current pattern of practice","volume":"48","author":"McMullen","year":"2005","journal-title":"Can J Surg"},{"key":"10.1016\/j.jss.2026.07.011_bib18","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/BF02605754","article-title":"The length of the anal canal","volume":"24","author":"Nivatvongs","year":"1981","journal-title":"Dis Colon Rectum"},{"key":"10.1016\/j.jss.2026.07.011_bib19","first-page":"183","article-title":"Definition of the rectum and level of the peritoneal reflection \u2013 still a matter of debate?","volume":"8","author":"Kenig","year":"2013","journal-title":"Wideochir Inne Tech Maloinwazyjne"},{"key":"10.1016\/j.jss.2026.07.011_bib20","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.suronc.2018.06.005","article-title":"The rectosigmoid problem","volume":"27","author":"D\u2019Souza","year":"2018","journal-title":"Surg Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib21","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000002889","article-title":"Recognition of anterior peritoneal reflections and their relationship with rectal tumors using rectal magnetic resonance imaging","volume":"95","author":"Yiqun","year":"2016","journal-title":"Medicine"},{"key":"10.1016\/j.jss.2026.07.011_bib22","doi-asserted-by":"crossref","first-page":"4330","DOI":"10.1016\/j.asjsur.2022.10.031","article-title":"Sigmoid take-off in rectosigmoid cancer as a landmark identifying benefit from neoadjuvant chemoradiation: a retrospective comparative cohort study","volume":"46","author":"Li","year":"2023","journal-title":"Asian J Surg"},{"key":"10.1016\/j.jss.2026.07.011_bib23","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/S1470-2045(09)70224-4","article-title":"Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis","volume":"10","author":"Georgiou","year":"2009","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib24","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1111\/j.1463-1318.2009.01769.x","article-title":"Understanding the anatomy of lymphatic drainage and the use of blue-dye mapping to determine the extent of lymphadenectomy in rectal cancer surgery: unresolved issues","volume":"11","author":"Bell","year":"2009","journal-title":"Colorectal Dis"},{"key":"10.1016\/j.jss.2026.07.011_bib25","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1055\/s-0036-1580632","article-title":"Radiation-Induced problems in colorectal surgery","volume":"29","author":"Ashburn","year":"2016","journal-title":"Clin Colon Rectal Surg"},{"key":"10.1016\/j.jss.2026.07.011_bib26","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5946\/ce.2020.288","article-title":"Radiation proctitis and management strategies","volume":"55","author":"Dahiya","year":"2022","journal-title":"Clin Endosc"},{"key":"10.1016\/j.jss.2026.07.011_bib27","article-title":"Factors associated with premature ovarian insufficiency in young women with locally advanced rectal cancer treated with pelvic radiation therapy","volume":"7","author":"Hilal","year":"2022","journal-title":"Adv Radiat Oncol"},{"key":"10.1016\/j.jss.2026.07.011_bib28","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/S0039-6109(16)46138-4","article-title":"Radiation injuries of the Colon and rectum","volume":"73","author":"Otchy","year":"1993","journal-title":"Surg Clin North America"},{"key":"10.1016\/j.jss.2026.07.011_bib29","doi-asserted-by":"crossref","first-page":"4025","DOI":"10.1200\/JCO.22.02166","article-title":"Risk-Adapted neoadjuvant chemoradiotherapy in rectal cancer: final report of the OCUM Study","volume":"41","author":"Ruppert","year":"2023","journal-title":"JCO"},{"key":"10.1016\/j.jss.2026.07.011_bib30","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/SLA.0b013e31820b8d52","article-title":"Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study","volume":"253","author":"Taylor","year":"2011","journal-title":"Ann Surg"},{"key":"10.1016\/j.jss.2026.07.011_bib31","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1056\/NEJMoa2303269","article-title":"Preoperative treatment of locally advanced rectal cancer","volume":"389","author":"Schrag","year":"2023","journal-title":"New Engl J Med"},{"key":"10.1016\/j.jss.2026.07.011_bib32","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.19325","article-title":"Limitations of meta-analyses of studies with high heterogeneity","volume":"3","author":"Imrey","year":"2020","journal-title":"JAMA Netw Open"}],"container-title":["Journal of Surgical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022480426004609?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022480426004609?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T19:14:48Z","timestamp":1793819688000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0022480426004609"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":42,"alternative-id":["S0022480426004609"],"URL":"https:\/\/doi.org\/10.1016\/j.jss.2026.07.011","relation":{},"ISSN":["0022-4804"],"issn-type":[{"value":"0022-4804","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Neoadjuvant Radiation Versus Upfront Surgery for Upper Rectal Cancer: A Systematic Review and Meta-Analysis of the Evidence","name":"articletitle","label":"Article Title"},{"value":"Journal of Surgical Research","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jss.2026.07.011","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}