Non-operative management of mismatch repair-deficient (dMMR) / micro satellite instability-high (MSI-H) colorectal cancer treated with immunotherapy: systematic review and meta-analysis - Summary - MDSpire
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Non-operative management of mismatch repair-deficient (dMMR) / micro satellite instability-high (MSI-H) colorectal cancer treated with immunotherapy: systematic review and meta-analysis
To synthesize evidence on non-operative ('watch-and-wait') management following immunotherapy in dMMR/MSI-H colorectal cancer, focusing on oncologic outcomes, recurrence, and organ preservation.
Key Findings:
Local regrowth was rare, with only 2% requiring salvage surgery.
Two-year recurrence-free survival (RFS) ranged from 98% to 100%, with a follow-up duration specified.
Overall survival (OS) was universally 100% in studies with ≥20 months follow-up.
Organ preservation was achieved in over 90% of patients.
Interpretation:
Non-operative management after immunotherapy yields excellent oncological outcomes in dMMR/MSI-H non-metastatic CRC, suggesting surgery may be safely deferred in selected patients achieving complete clinical response.
Limitations:
Small sample sizes, particularly for colon cancer, limiting generalizability of findings.
Heterogeneity in treatment regimens and response assessment criteria may affect the reliability of outcomes.
Short median follow-up (<3 years) precludes firm conclusions about long-term outcomes.
Most studies were single-arm, introducing potential selection bias.
Conclusion:
Immunotherapy offers superior disease control and functional preservation compared to conventional approaches, with potential applicability in colon cancer; further research is needed to validate these findings.
