Lateral pelvic lymphadenectomy for low rectal cancer: a META-analysis of recurrence rates

Abstract

Background Locoregional recurrence (LR) remains a problem for patients with lower rectal cancer despite standardized surgery and improved neoadjuvant treatment regimens. Lateral pelvic lymph node dissection (LPLND) has been routine practice for some time in the Orient/East, but other regions have concerns about morbidity. As perioperative care and surgical approaches are refined, this has been revisited for selected patients. The question as to whether LPLND improves oncological outcomes was explored here. Methods A systematic review of patients who underwent TME with or without LPLND from 2000 to 2020 was performed. The primary endpoint was the rate of LR between the two groups.Results Seven papers met the predefined search criteria in which 2000 patients underwent TME alone, while 1563 patients had TME and LPLND. The rate of LR was marginally higher with TME alone when compared with TME plus LPLND, but this result was not statistically significant (9.8 vs 9.4%, odds ratio 0.75, 95% CI 0.41-1.38, *p = 0.35). In addition, four studies reported on distant recurrence rates, with TME and LPLND showing a slight reduction in overall rates (27.3 vs 29.9%, respectively, OR 0.65, 95% CI 0.45-0.92, *p = 0.02). Conclusion The addition of LPLND to TME is not associated with a significantly lower risk of LR in patients who undergo surgery for lower rectal cancer.

Management, treatment and prognostic significance of lateral lymph node metastases in rectal cancer—a regional cohort study

“…Some studies have shown reduced risk of local recurrence when LLND is performed, both in patients with or without MRI-suspected LLNM [9,24]. However, in a meta-analysis by Fahy et al no such benefit was observed [25]. Moreover, it has been suggested that LLND results in longer operative time, greater intraoperative blood loss, increase in postoperative complications and increased incidence of dysuria and impaired sexual functions without subsequent improvement of survival [26][27][28].…”

Oncological outcome after lateral pelvic lymphadenectomy for low rectal carcinoma: not only an N‐status matter

“…Recently published meta‐analyses of retrospective and prospective studies and RCTs comparing the total mesorectal excision (TME) with prophylactic and therapeutic LPLND and the TME alone showed no differences in terms of survival and recurrence and greater postoperative complications, such as urinary and sexual dysfunction, in the TME with LPLND group. The results remained consistent in patients with or without neoadjuvant chemoradiotherapy 1–6 . On the other hand, long‐term follow‐up data from the JCOG0212 randomized clinical trial did not support the noninferiority of mesorectal excision (ME) alone compared with ME with LPLND in patients with stage II and III low rectal cancer who did not meet size‐based imaging criteria predictive of lateral pelvic lymph node (LPLN) metastasis; the cumulative local recurrence rate was significantly lower in the ME with LPLND group than in the ME group.…”

“…The results remained consistent in patients with or without neoadjuvant chemoradiotherapy. [1][2][3][4][5][6] On the other hand, long-term follow-up data from the JCOG0212 randomized clinical trial did not support the noninferiority of mesorectal excision (ME) alone compared with ME with LPLND in patients with stage II and III low rectal cancer who did not meet size-based imaging criteria predictive of lateral pelvic lymph node (LPLN) metastasis; the cumulative local recurrence rate was significantly lower in the ME with LPLND group than in the ME group. As the difference was mostly due to decreased lateral pelvic recurrences, the authors concluded that LPLND may effectively treat nonenlarged metastatic LPLNs.…”

Lateral pelvic lymphadenectomy for low rectal cancer

“…Although local recurrence rates have decreased & disease-free survival has increased over past 20 years, therapy of rectal cancer has changed (2). Treatment of locally advanced rectal cancer presents difficulties for both clinicians & studied cases in terms of influence on long-term functional & cancer-specific outcomes as well as degree of aggressiveness of treatment (3). usual therapies for advanced low-rectal cancer to lessen local recurrence have been preoperative chemoradiotherapy & total mesorectal excision.…”