Restaging Patients with Rectal Cancer Following Neoadjuvant Chemoradiation: A Systematic Review

Leah E. Hendrick, Renee L. Levesque, Nathan M. Hinkle, Justin J. Monroe, Evan S. Glazer, Jeremiah L. Deneve, Danny Yakoub, David Shibata, Paxton V. Dickson

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Background: In the USA, most patients with clinical stage II/III rectal cancer receive neoadjuvant chemoradiation (chemo/XRT) over 5–6 weeks followed by a 6–10-week break before proctectomy. As chemotherapy is delivered at radio-sensitizing doses, there is essentially a 3-month window during which potential systemic disease is untreated. Evidence regarding the utility of restaging patients prior to proctectomy is limited. Methods: PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies evaluating the utility of restaging patients with rectal cancer after completion of long-course chemo/XRT, and reporting associated changes in management. Studies that were non-English, included <50 patients, or examining the diagnostic accuracy of imaging modalities were excluded. Study quality was evaluated using the modified Newcastle Ottawa Scale. Results: Eight studies were identified including a total of 1251 patients restaged between completion of chemo/XRT and proctectomy. All studies were retrospective. Restaging identified new metastatic disease in 72 (6.0%) patients, with 4 studies reporting specific sites: liver (n = 28), lung (n = 8), adrenal (n = 1), bone (n = 1), and multiple sites (n = 7). Overall progression (distant or local) was detected in 88 (7.0%) patients and resulted in a change in management in 77 (87.5%) of these patients. Tumor-related prognostic characteristics were inconsistently reported among studies, precluding meta-analysis. Conclusions: Although restaging between completion of neoadjuvant chemo/XRT and proctectomy detects disease progression in only a small percentage of patients, findings alter the treatment plan in the vast majority of these patients. Multi-institutional collaboration with analysis of well-defined prognostic variables may better identify patients most likely to benefit from restaging.

Original languageEnglish (US)
Pages (from-to)973-979
Number of pages7
JournalWorld Journal of Surgery
Issue number3
StatePublished - Mar 1 2020
Externally publishedYes

ASJC Scopus subject areas

  • Surgery


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