Lateral Pelvic Lymph Node Metastases in Rectal Cancer: A Systematic Review

Atef, Y.; Koedam, T. W. A.; Oostendorp, S. E. van; Bonjer, H. Jaap; Wijsmuller, A. R.; Tuynman, Jurriaan B.

doi:10.1007/s00268-019-05135-3

Cited by 26 publications

(26 citation statements)

References 63 publications

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“…The efficacy of NCRT in sterilizing pelvic sidewall nodes has been studied extensively. A recent systematic review and meta‐analysis 29 reported that between 25 and 85 per cent of persistent clinically suspicious pelvic sidewall nodes following NCRT contained pathologically proven metastasis, and 20 per cent of radiologically responsive nodes contained metastases. The longer‐term significance and oncological outcomes were not considered in this review.…”

Section: Highly Selective Therapeutic Lateral Pelvic Node Dissection mentioning

confidence: 99%

“…An RCT 44 comparing TME with and without LPND after NCRT is recruiting patients, although concerns exist about the method of randomization before restaging MRI, which may lead to overtreatment of some patients and undertreatment of others 29 . This may influence recruitment and highlights the difficulty in conducting randomized trials in an ever‐changing scientific background.…”

Section: Directions For Future Researchmentioning

confidence: 99%

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Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management

Williamson

Quyn

Sagar

2020

British Journal of Surgery

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Background: The management of lateral pelvic lymphadenopathy in low rectal cancer poses an oncological and technical challenge. Interpretation of the literature is confounded by different approaches to management in the East and West, and a lack of randomized data from which to draw accurate conclusions regarding the optimal approach. Recent collaboration between Eastern and Western centres has increased the standardization of care. Despite this, significant differences in international guidelines remain. The aim of this review was to appraise the available literature and propose a management algorithm. Methods: A literature review of all relevant studies was performed to summarize the historical evidence, as well as establish the significance of clinically positive lateral pelvic sidewall nodes, and the role of neoadjuvant chemoradiotherapy and lateral pelvic node dissection. A management algorithm was developed based on this review of the literature. Results: The management of pelvic sidewall lymphadenopathy in rectal cancer is non-standardized, with geographical differences. The mechanism of lateral lymphatic spread is well defined; the risk increases with lower tumour height and advanced T category. Existing data indicate that acceptable disease-free and overall survival can be achieved by neoadjuvant chemoradiotherapy with selective lateral pelvic node dissection. Conclusion: Suspicious lateral pelvic sidewall nodes, particularly in the internal iliac chain, should be considered as resectable locoregional disease, and surgery offered for enlarged nodes that do not respond to neoadjuvant chemoradiotherapy.

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Section: Highly Selective Therapeutic Lateral Pelvic Node Dissection mentioning

confidence: 99%

Section: Directions For Future Researchmentioning

confidence: 99%

Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management

Williamson

Quyn

Sagar

2020

British Journal of Surgery

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“…In contrast, the place of LLND remains a matter of controversy between Eastern and Western surgical guidelines (7)(8)(9)(10)(11)(12). The main conceptual difference is the fact that the lateral pelvic lymph nodes are considered as localized disease in Japanese clinical practice, whereas the West treats them as systemic disease (13)(14)(15). For this reason, in Japan, prophylactic LLND is always performed in patients with stage II/III lower rectal cancer, whereas in the West, chemoradiotherapy (CRT) is routinely performed, thus generally avoiding a more invasive surgical approach (16).…”

Section: Introductionmentioning

confidence: 99%

Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients

Anania

Davies

Arezzo

et al. 2021

Int J Colorectal Dis

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The role of lateral lymph node dissection (LLND) during total mesorectal excision (TME) for rectal cancer is still controversial. Many reviews were published on prophylactic LLND in rectal cancer surgery, some biased by heterogeneity of overall associated treatments. The aim of this systematic review and meta-analysis is to perform a timeline analysis of different treatments associated to prophylactic LLND vs no-LLND during TME for rectal cancer. Methods A literature search was performed in PubMed, SCOPUS and WOS for publications up to 1 September 2020. We considered RCTs and CCTs comparing oncologic and functional outcomes of TME with or without LLND in patients with rectal cancer. Results Thirty-four included articles and 29 studies enrolled 11,606 patients. No difference in 5-year local recurrence (in every subgroup analysis including preoperative neoadjuvant chemoradiotherapy), 5-year distant and overall recurrence, 5-year overall survival and 5-year disease-free survival was found between LLND group and non LLND group. The analysis of post-operative functional outcomes reported hindered quality of life (urinary, evacuatory and sexual dysfunction) in LLND patients when compared to non LLND. Conclusion Our publication does not demonstrate that TME with LLND has any oncological advantage when compared to TME alone, showing that with the advent of neoadjuvant therapy, the advantage of LLND is lost. In this review, the most important bias is the heterogeneous characteristics of patients, cancer staging, different neoadjuvant therapy, different radiotherapy techniques and fractionation used in different studies. Higher rate of functional post-operative complications does not support routinely use of LLND.

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“…In a randomized controlled trial of 51 patients by Nagawa et al 27 neoadjuvant radiation before surgery with EL did not improve disease‐free survival or recurrence rates, supporting neoadjuvant therapy can be employed as an alternative to EL. It is likely both a neoadjuvant treatment strategy with TME and TME plus EL either sterilizes or removes RLPN disease to clear the circumferential resection margin, which is supported by their equivocal oncologic outcomes 28 …”

Section: Discussionmentioning

confidence: 99%

Radiological assessment of persistent retroperitoneal and lateral pelvic lymph nodes after neoadjuvant therapy for rectal cancer: An analysis of the United States Rectal Cancer Consortium

Turgeon

Gamboa

Keilson

et al. 2021

Journal of Surgical Oncology

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Introduction Management of retroperitoneal and lateral pelvic lymph nodes (RLPN) in rectal cancer remains unclear. With total neoadjuvant therapy (TNT), more patients have radiologic complete clinical response (rCR). We sought to evaluate the impact of radiographic persistent RLPN after neoadjuvant therapy on survival. Materials and Methods Patients with rectal adenocarcinoma with isolated RLPN metastasis, who received neoadjuvant therapy before surgery were included from the United States Rectal Cancer Consortium database. Primary outcomes were recurrence‐free survival (RFS) and overall survival (OS). Results Of 77 patients, all received neoadjuvant therapy, with 35 (46%) receiving TNT. Posttreatment, 33 (43%) had rCR while 44 (57%) had radiographic persistent RLPN. Median number of radiographic positive RLPN was 1 (IQR 1–2). Receipt of TNT was associated with radiographic RLPN rCR (OR 4.77, 95% CI 1.81–12.60, p < .01). However, there was no difference in RFS and OS between patients who achieved rCR or with persistent RLPN (all p > .05). Conclusions Radiographic persistence of RLPN was not associated with worse survival in well‐selected patients and may not be a reliable indicator of pathological response. TNT may be the preferred management strategy to select patients given its association with rCR. Radiographic persistence of RLPN after preoperative therapy should not necessarily preclude surgery.

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Lateral Pelvic Lymph Node Metastases in Rectal Cancer: A Systematic Review

Cited by 26 publications

References 63 publications

Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management

Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management

Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients

Radiological assessment of persistent retroperitoneal and lateral pelvic lymph nodes after neoadjuvant therapy for rectal cancer: An analysis of the United States Rectal Cancer Consortium

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