{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T05:22:31Z","timestamp":1794288151622,"version":"4.9.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Contemporary rectal cancer management increasingly relies on MRI-based risk stratification to identify low-risk cT3 tumors that may avoid neoadjuvant therapy. This meta-analysis compared upfront total mesorectal excision with neoadjuvant therapy in MRI-defined low-risk cT3 rectal cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      PubMed, Scopus, and Cochrane Central were systematically searched through June 2025. Pooled odds ratios (ORs), mean differences (MDs), and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed with the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic. Analyses were performed using R (version 4.4.2). A complementary Bayesian random-effects meta-analysis was performed to explore posterior uncertainty and potential equivalence between strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five studies, including 1447 patients, were analyzed. Upfront surgery was associated with shorter operative time (MD \u221225.7 min; 95% CI \u221238.6 to \u221212.7) and more lymph nodes retrieved (MD 6.6; 95% CI 6.0-7.3). No significant differences were observed in perioperative complications, including anastomotic leaks, intra-abdominal abscesses, or reoperations. Oncologic outcomes were comparable, including circumferential resection margin positivity (CRM+) (OR 1.05; 95% CI 0.49-2.26), local recurrence (OR 0.99; 95% CI 0.58-1.70), and distant recurrence (OR 1.03; 95% CI 0.64-1.65). Survival outcomes were also similar, with no differences in disease-free (DFS) or overall survival (OS). Bayesian analyses supported these findings, with effect estimates centered around the null and probabilities of superiority close to equipoise, indicating inconclusive evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In MRI-defined low-risk cT3 rectal cancer, upfront TME may provide oncologic outcomes comparable to neoadjuvant therapy. However, the available evidence remains exploratory and insufficient to support definitive treatment recommendations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261465395","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:29:52Z","timestamp":1782494992000},"page":"3378-3391","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Upfront Total Mesorectal Excision for MRI-Defined Low-Risk cT3 Rectal Cancer: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2960-3810","authenticated-orcid":false,"given":"Bernardo Fontel","family":"Pompeu","sequence":"first","affiliation":[{"name":"Heliopolis Hospital"},{"name":"Department of Surgery, University of S\u00e3o Caetano do Sul"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila Haddad","family":"Baptista","sequence":"additional","affiliation":[{"name":"Heliopolis Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thais Henriques","family":"Abud","sequence":"additional","affiliation":[{"name":"Heliopolis Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateus Lima Ulisses","family":"Trindade","sequence":"additional","affiliation":[{"name":"Heliopolis Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Eduarda Caetano Batista","family":"de Paiva","sequence":"additional","affiliation":[{"name":"Heliopolis Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Leal","family":"Barone","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of S\u00e3o Caetano do Sul"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7687-3073","authenticated-orcid":false,"given":"Lucas Monteiro","family":"Delgado","sequence":"additional","affiliation":[{"name":"Medical School, Federal University of Minas Gerais"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Theis","sequence":"additional","affiliation":[{"name":"University of North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Mazzola","family":"Poli de Figueiredo","sequence":"additional","affiliation":[{"name":"University of North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Bellotti","family":"Formiga","sequence":"additional","affiliation":[{"name":"Heliopolis Hospital"},{"name":"Hospital of Santa Casa de Misericordia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21772"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2303269"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2016.06.007"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.00903"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-020-02034-2"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000006362"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40880-018-0342-8"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.34.9068"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-010-0513-5"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4832-5"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.12.027"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/08941939.2018.1469696"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-019-03446-4"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.16451"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2017.04.007"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cireng.2025.800145"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31820b8d52"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00079-6"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30555-6"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_4_22_2","article-title":"Upfront surgery versusneoadjuvant chemoradiotherapy in rectal cancer: a systematic review andmeta-analysis [Internet]","author":"Pompeu BF","year":"2025","unstructured":"Pompeu BF, Formiga FB. 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