Systematic review and meta-analysis of long-term oncological outcomes of lateral lymph node dissection for metastatic nodes after neoadjuvant chemoradiotherapy in rectal cancer |
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| Institution: | 1. Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia;2. Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia;3. Department of Surgery, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands;4. Department of Surgical Oncology, Division of Surgery, MD Anderson Cancer Center, Houston, TX, USA;1. Department of Surgical Sciences, Department of Colorectal Surgery, Uppsala University, 752 36, Uppsala, Sweden;2. Department of Surgical Sciences, Department of Colorectal Surgery, Uppsala University Hospital, S-751 85, Uppsala, Sweden;1. Peter MacCallum Cancer Centre, Division of Surgical Oncology, Australia;2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia;3. Peter MacCallum Cancer Centre, Division of Medical Oncology, Australia;4. Peter MacCallum Cancer Centre, Division of Cancer Imaging, Australia;5. Peter MacCallum Cancer Centre, Division of Anatomical Pathology, Australia;1. Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China;2. Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China;3. Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, China;4. Department of General Surgery (Thyroid Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China;5. Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, China;1. Department of Surgery - Maastricht University Medical Centre +, PO Box 5800, 6202, AZ, Maastricht, the Netherlands;2. Department of Surgery - School for Oncology and Developmental Biology (GROW) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands;3. Physiotherapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht, the Netherlands;4. Department of Nutrition and Movement Sciences - School of Nutrition and Translational Research in Metabolism (NUTRIM) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands;5. Department of Epidemiology - Care and Public Health Research Institute (CAPHRI) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands;6. Department of Surgery - School of Nutrition and Translational Research in Metabolism (NUTRIM) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands;7. Top Sector Life Sciences and Health (Health～Holland), Wilhelmina van Pruisenweg 104, 2595, AN, The Hague, the Netherlands;8. Department of Anaesthesiology - Erasmus Medical Centre, PO Box 2040, 3000, CA, Rotterdam, the Netherlands;1. Washington Cancer Institute, Program in Peritoneal Surface Malignancy Washington, DC, USA;2. Westat, Rockville, MD, USA |
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| Abstract: | BackgroundStandard Western management of rectal cancers with pre-treatment metastatic lateral lymph nodes (LLNs) is neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). In recent years, there is growing interest in performing an additional lateral lymph node dissection (LLND). The aim of this systematic review and meta-analysis was to investigate long-term oncological outcomes of nCRT followed by TME with or without LLND in patients with pre-treatment metastatic LLNs.MethodsPubMed, Ovid MEDLINE, Embase, Cochrane Library and Clinicaltrials.gov were searched to identify comparative studies reporting long-term oncological outcomes in pre-treatment metastatic LLNs of nCRT followed by TME and LLND (LLND+) vs. nCRT followed by TME only (LLND-). Newcastle-Ottawa risk-of-bias scale was used. Outcomes of interest included local recurrence (LR), disease-free survival (DFS), and overall survival (OS). Summary meta-analysis of aggregate outcomes was performed.ResultsSeven studies, including 946 patients, were analysed. One (1/7) study was of good-quality after risk-of-bias analysis. Five-year LR rates after LLND+ were reduced (range 3–15%) compared to LLND- (11–27%; RR = 0.40, 95%CI 0.25–0.62], p < 0.0001). Five-year DFS was not significantly different after LLND+ (range 61–78% vs. 46–79% for LLND-; RR = 0.72, 95%CI 0.51–1.02], p = 0.143), and neither was five-year OS (range 69–91% vs. 72–80%; RR = 0.72, 95%CI 0.45–1.14], p = 0.163).ConclusionIn rectal cancers with pre-treatment metastatic LLNs, nCRT followed by an additional LLND during TME reduces local recurrence risk, but does not impact disease-free or overall survival. Due to the low quality of current data, large prospective studies will be required to further determine the value of LLND. |
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| Keywords: | Rectal cancer Locally advanced rectal cancer Lateral lymph nodes Lateral pelvic nodes Neoadjuvant chemoradiotherapy Lateral lymph node dissection |
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