Less Than 12 Lymph Nodes in The Surgical Specimen after Neo-Adjuvant Chemo-Radiotherapy in Rectal Cancer: Five Years Survival Analysis

Dev, Kapil; Shivran, N.; Gurawalia, Jaiprakash; Pandey, Arun K.; Kumar, Shiva; Kurpad, Vishnu; Nayak, Srishti; Arjunan, Ravi

doi:10.1016/j.ejso.2019.11.179

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“…The prognostic impact of resecting more than 12 LNs and fewer than 12 LNs after neoadjuvant treatment for rectal cancer is controversial. For example, Dev et al [ 30 ] found that resecting fewer than 12 LNs in rectal cancer patients undergoing neoadjuvant radiotherapy should be considered a better prognostic factor, but Wang et al [ 31 ] and Lykke et al [ 18 ] believed that resecting at least 12 LNs is an independent and favorable prognostic factor for rectal cancer after neoadjuvant therapy. Moreover, Khan et al [ 32 ] and La Torre et al [ 19 ] believed that at least 12 LNs dissected after neoadjuvant treatment of rectal cancer do not affect the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of at least 12 lymph nodes after neoadjuvant therapy in rectal cancer: A meta-analysis

Tan¹,

Liu²,

Ma³

et al. 2020

WJGO

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BACKGROUND The number of dissected lymph nodes (LNs) in rectal cancer after neoadjuvant therapy has a controversial effect on the prognosis. AIM To investigate the prognostic impact of the number of LN dissected in rectal cancer patients after neoadjuvant therapy. METHODS We performed a systematic review and searched PubMed, Embase (Ovid), MEDLINE (Ovid), Web of Science, and Cochrane Library from January 1, 2000 until January 1, 2020. Two reviewers examined all the publications independently and extracted the relevant data. Articles were eligible for inclusion if they compared the number of LNs in rectal cancer specimens resected after neoadjuvant treatment (LNs ≥ 12 vs LNs < 12). The primary endpoints were the overall survival (OS) and disease-free survival (DFS). RESULTS Nine articles were included in the meta-analyses. Statistical analysis revealed a statistically significant difference in OS [hazard ratio (HR) = 0.76, 95% confidence interval (CI): 0.66-0.88, I 2 = 12.2%, P = 0.336], DFS (HR = 0.76, 95%CI: 0.63-0.92, I 2 = 68.4%, P = 0.013), and distant recurrence (DR) (HR = 0.63, 95%CI: 0.48-0.93, I 2 = 30.5%, P = 0.237) between the LNs ≥ 12 and LNs < 12 groups, but local recurrence (HR = 0.67, 95%CI: 0.38-1.16, I 2 = 0%, P = 0.348) showed no statistical difference. Moreover, subgroup analysis of LN negative patients revealed a statistically significant difference in DFS (HR = 0.67, 95%CI: 0.52-0.88, I 2 = 0%, P = 0.565) between the LNs ≥ 12 and LNs < 12 groups. CONCLUSION Although neoadjuvant therapy reduces LN production in rectal cancer, our data indicate that dissecting at least 12 LNs after neoadjuvant therapy may improve the patients’ OS, DFS, and DR.

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