Lateral pelvic lymphadenectomy for low rectal cancer: a META-analysis of recurrence rates
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ORIGINAL ARTICLE
Lateral pelvic lymphadenectomy for low rectal cancer: a META-analysis of recurrence rates M. R. Fahy 1 & M. E. Kelly 1 & T. Nugent 2 & E. Hannan 3 & D. C. Winter 3 Accepted: 17 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Lateral pelvic lymph node dissection . Local recurrence . Rectal cancer . Surgical strategies . Surgical outcomes . Survival outcomes
Introduction Colorectal cancer (CRC) is the third most common cause of cancer-related death worldwide [1]. The incidence of localized, early CRC has increased in recent decades, in large part due to improved screening programmes [2]. However, 5–10% of patients still present with locally advanced disease [3, 4]. The management of locally advanced rectal cancer (LARC) poses unique challenges to both clinicians and patients regard* M. R. Fahy [email protected] 1
University College Dublin, Dublin, Ireland
2
Trinity College Dublin, Dublin, Ireland
3
Department of Surgery, St Vincent’s University Hospital, Dublin, Ireland
ing aggressiveness of treatment and the impact to long-term functional and cancer-specific outcomes [5–7]. Standardized total mesorectal excision (TME) with neoadjuvant chemoradiotherapy (NCRT) has significantly improved locoregional recurrence (LR) rates [8, 9]. LR is now estimated to occur in 4–10% of patients with rectal cancer [10, 11]. However, some units have recently reported higher recurrence rates with trans-anal TME (taTME), which has caused considerable debate [12]. Other concerns with regard to surgical approach and radicality of resection include organ preservation, protection of autonomic nerve supply and the potential
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