Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis

Significance and Mechanism of Lymph Node Metastasis in Cancer Progression

“…Preoperative radiotherapy reduced the relative risk of local recurrence, although without significant survival improvement (16,17). Although a recent meta-analysis comparing extended and nonextended lymphadenectomy of the lateral pelvic LN showed no overall difference in cancer-specific outcome (18), this study has limitations such as varying protocols, different levels of surgical expertise, different patient populations, and different time periods. In many Western countries, current standard therapy for lower rectal cancer is total mesorectal excision (TME) with preoperative radiotherapy.…”

Laparoscopic Surgery for Rectal Cancer: Approaches, Challenges and Outcome

“…These were originally described in open surgery, but more recently these extended resections have been also offered laparoscopically (Georgiou et al, 2009;Stelzner et al, 2011).…”

“…6 to 27% (Fujita et al, 2003;Kim et al, 2008). However, evidence from metaanalysis confirms that extended lateral pelvic node dissection is associated with increased blood loss and urinary and sexual dysfunction without significant overall cancer-specific advantage (Georgiou et al, 2009). Therefore, preoperative radiotherapy or chemoradiotherapy followed by rectal resection with total mesorectal excision is the standard treatment in Western countries.…”

Lateral pelvic lymph node dissection and radiation treatment for rectal cancer: Mutually exclusive or mutually beneficial?

“…The rates of local control were again not different between TME preceded by radiotherapy versus TME with lateral pelvic lymph node dissection (with the caveat that in the Dutch TME trial, the rate of radial margin positivity for distal disease was unacceptably high at more than 20%). A 2009 meta‐analysis also showed no difference in local recurrence, overall or disease‐free survival between “extended lymphadenectomy” including the lateral compartment versus neoadjuvant treatment without extended lymphadenectomy 12. Increased rates of male sexual and urinary dysfunction were noted in the lymphadenectomy group, but this was not supported by the more recent JCOG0212 data 12, 13…”

“…A 2009 meta‐analysis also showed no difference in local recurrence, overall or disease‐free survival between “extended lymphadenectomy” including the lateral compartment versus neoadjuvant treatment without extended lymphadenectomy 12. Increased rates of male sexual and urinary dysfunction were noted in the lymphadenectomy group, but this was not supported by the more recent JCOG0212 data 12, 13…”