Survival and safety after neoadjuvant chemotherapy or upfront surgery for locally advanced colon cancer: meta-analysis.

"Disclosure J.A. is the principal investigator of the ELECLA clinical trial. The authors declare no other conflict of interest."

"Funding The authors have no funding to declare."

"RCTs, prospective controlled studies, and propensity score-matched studies comparing one arm of patients diagnosed with potentially resectable and non-metastatic LACC treated with NAC versus at least one arm of patients treated with upfront surgery and adjuvant therapy were eligible. The inclusion criteria for the studies were as follows: biopsy-confirmed LACC (T3–4 Nx–2 M0); neoadjuvant and adjuvant therapy using chemotherapy alone. Studies that included rectal cancer, included early-stage (T1 or T2) CC, included recurrent tumours, or focused on radiation therapy or chemoradiation as neoadjuvant or adjuvant treatment were excluded, as were retrospective cohort or case–control studies, reviews, editorials, case reports, meta-analyses, and conference abstracts. Patients presenting with bowel obstruction were also included in this study. The primary objective was to compare overall survival (OS) (considered as months from diagnosis to death, regardless of disease recurrence) and disease-free survival (DFS) (considered as months after diagnosis with no signs or symptoms of recurrence). As a secondary objective, postoperative outcomes (overall morbidity according to Clavien–Dindo, perioperative mortality up to 90 days, anastomotic leakage or intra-abdominal abscess, and rate of complete resection (R0)) were compared. The inclusion criteria for the survival analysis were studies that provided Kaplan–Meier curves detailing the OS and DFS of the entire participant group. This review was registered in PROSPERO, the international prospective register of systematic reviews (registration number CRD42023422028) () and is reported in adherence to the PRISMA guidelines (), as well as the recommendations of Cochrane,."