Review Prognosis of local resection of tumor after neoadjuvant radiotherapy versus radical tumor resection for low rectal cancer: a systematic review and meta-analysis Zhigang Bai, Department of General Surgery, Beijing Friendship Hospital Background: The traditional treatment for low rectal cancer is radical surgery after neoadjuvant radiotherapy (CRT). For patients who refuse stoma or are unsuitable for RS, another optional approach may be local excision (LE) using preoperative CRT for patients in local remission. The purpose of this systematic evaluation was to determine whether there are differences in local recurrence (LR), overall survival (OS), and disease-free survival (DFS) between patients treated with CRT+LE and CRT+RS. Methods A literature search was performed using MEDLINE/ PubMed/ Ovid databases and Google Scholar, ranging between 1946 and 2013.Studies comparing the prognosis of LE and RS after CRT were included. Pooled analyses used a model with Mantel-Haenszel statistics (random effects) to determine differences in LR, OS, and DFS between CRT+ LE and CRT+ RS. Results Eight studies were suitable for pooled analysis of LR, while five and four studies, respectively, were analyzed for OS and DFS. the LR rate was higher in the LE group when RS was used as the reference group. However, the difference was not statistically significant (ratio (OR) 1.29, confidence interval (CI) 0.72-2.31, p-value = 0.40). Similarly, looking at OS at 10 years (OR 0.96, CI 0.38-2.43, p = 0.93) and DFS at 5 years (OR 1.04, CI 0.61-1.76, p = 0.89), the difference between LE and RS groups was not statistically significant. There was evidence of publication bias in the literature using DFS studies. In a subgroup analysis of T3/any N staging, the above results showed no difference between the LE and RS groups. Conclusions With the current combined evidence, no statistically significant differences in LR, OS, and DFS rates were observed between patients with rectal cancer after CRT treated with LE and those treated with RS.LE after CRT may be a viable alternative for some patients who wish to avoid RS. However, further randomized clinical studies are needed to confirm these results.