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

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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.

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References

  1. Rawla P, Sunkara T, Barsouk A (2019) Epidemiology of colorectal cancer: incidence, mortality, survival and risk factors. Prz Gastroenterol 14(2):89–103

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB (2019) Colorectal Cancer. Lancet 394:167–180

    Google Scholar 

  3. De Wilt JHW, Vermaas M, Ferenschild FTJ, Verhoef C (2007) Management of locally advanced primary and recurrent rectal cancer. Clin Colon Rectal Surg 20(3):255–264

    PubMed  PubMed Central  Google Scholar 

  4. Beyond TME Collaborative (2013) Beyond TME collaborative consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg 100(8):1009–1014

    Google Scholar 

  5. Yamada K, Ishizawa T, Niwa K, Chuman Y, Aikou T (2002) Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 45:1078–1084

    PubMed  Google Scholar 

  6. Kokelaar RF, Evans MD, Davies M, Harris DA, Beynon J (2016) Locally advanced rectal cancer: management challenges. Onco Targets Ther 9:6265–6272

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Nielsen M, Rasmussen P, Lindegaard J et al (2012) A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database. Color Dis 14:1076–1083

    CAS  Google Scholar 

  8. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, Van Krieken JH, Leer JW, Van de Velde CJ (2001) Dutch colorectal cancer group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646

    CAS  PubMed  Google Scholar 

  9. Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336:980–987

    Google Scholar 

  10. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1:1479–1482

    CAS  PubMed  Google Scholar 

  11. Platell CF (2007) Changing patterns of recurrence after treatment for colorectal cancer. Int J Color Dis 22(10):1223–1231

    Google Scholar 

  12. Fearnhead NS, Acheson AG, Brown SR, Hancock L et al (2020) The ACPGBI recommends pause for reflection on transanal total mesorectal excision. Colorectal Dis 22(7):745–748

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, Sawada T (2001) Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44(9):1274–1280

    CAS  PubMed  Google Scholar 

  14. Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls RJ, Tekkis P (2009) Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 10:1053–1062

    PubMed  Google Scholar 

  15. Hashiguchi Y, Muro K, Saito Y et al (2019) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25(1):1–42

    PubMed  PubMed Central  Google Scholar 

  16. Ueno H, Mochizuki H, Hashiguchi Y, Hase K (2001) Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg 234(2):190–197

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Kim TH, Jeong SY, Choi DH et al (2019) Oncological outcomes of patients with locally advanced rectal cancer and lateral pelvic lymph node involvement. J Gastrointest Surg 23:1454–1460

    Google Scholar 

  18. Yamada K, Ishizawa T, Niwa K, Chuman Y, Akiba S, Aikou T (2001) Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer. Br J Surg 88(7):988–993

    CAS  PubMed  Google Scholar 

  19. Tanis PJ, Doeksen A, van Lanschot JJ (2013) Intentionally curative treatment of locally recurrent rectal cancer: a systematic review. Can J Surg 56:135–144

    PubMed  PubMed Central  Google Scholar 

  20. Camilleri-Brennan J, Steele RJ (2001) The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol 27(4):349–353

    CAS  PubMed  Google Scholar 

  21. Akasu T, Sugihara K, Moriya Y (2009) Male urinary and sexual functions after mesorectal excisions alone or in combination with extended lateral pelvic lymph node dissection for rectal cancer. Ann Surg Oncol 16(10):2779–2786

    PubMed  Google Scholar 

  22. Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg 255(6):1129–1134

    PubMed  Google Scholar 

  23. Hojo K, Sawada T, Moriya Y (1989) An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 32(2):128–133

    CAS  PubMed  Google Scholar 

  24. Moriya Y, Sugihara K, Akasu T, Fujita S (1997) Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 21(7):728–732

    CAS  PubMed  Google Scholar 

  25. Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K, Muto T (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663–1672

    PubMed  Google Scholar 

  26. Akasu T, Sugihara K, Moriya Y (2009) Male urinary and sexual functions after mesorectal excision alone or in combination with extended lateral pelvic lymph node dissection for rectal cancer. Ann Surg Oncol 16(10):2779–2786

    PubMed  Google Scholar 

  27. Tokuhara K, Hishikawa H, Yoshida T, Ueyama Y, Yoshioka K, Sekimoto M (2020) Laparoscopic versus open selective lateral pelvic lymph node dissection following total mesorectal excision for locally advanced low rectal cancer. Int J Color Dis 35(7):1301–1309

    Google Scholar 

  28. Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    PubMed  PubMed Central  Google Scholar 

  29. Hozo SP, Djulbegovic G, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    PubMed  PubMed Central  Google Scholar 

  30. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003 Sep) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    PubMed  Google Scholar 

  31. Esnaola NF, Cantor SB, Johnson ML, Mirza AN, Miller AR, Curley SA, Crane CH, Cleeland CS, Janjan NA, Skibber JM (2002) Pain and quality of life after treatment in patients with locally recurrent rectal cancer. J Clin Oncol 20(21):4361–4367

    PubMed  Google Scholar 

  32. Detering R, Karthaus EG, Borstlap WAA, Marijnen CAM, van de Velde CJH, Bemelman WA, Beets GL, Tanis PJ, Aalbers AGJ, Aalbers AGJ, Acherman Y, Algie GD, Alting von Geusau B, Amelung F, Aukema TS, Bakker IS, Bartels SA, Basha S, Bastiaansen AJNM, Belgers E, Bleeker W, Blok J, Bosker RJI, Bosmans JW, Boute MC, Bouvy ND, Bouwman H, Brandt-Kerkhof A, Brinkman DJ, Bruin S, Bruns ERJ, Burbach JPM, Burger JWA, Buskens CJ, Clermonts S, Coene PPLO, Compaan C, Consten ECJ, Darbyshire T, de Mik SML, de Graaf EJR, de Groot I, tot Nederveen Cappel RJV, de Wilt JHW, van der Wolde J, Boer FC, Dekker JWT, Demirkiran A, Derkx-Hendriksen M, Dijkstra FR, van Duijvendijk P, Dunker MS, Eijsbouts QE, Fabry H, Ferenschild F, Foppen JW, Furnee EJB, Gerhards MF, Gerven P, Gooszen JAH, Govaert JA, van Grevenstein WMU, Haen R, Harlaar JJ, van der Harst E, Havenga K, Heemskerk J, Heeren JF, Heijnen B, Heres P, Hoff C, Hogendoorn W, Hoogland P, Huijbers A, Janssen P, Jongen AC, Jonker FH, Karthaus EG, Keijzer A, Ketel JMA, Klaase J, Kloppenberg FWH, Kool ME, Kortekaas R, Kruyt PM, Kuiper JT, Lamme B, Lange JF, Lettinga T, Lips DJ, Logeman F, Lutke Holzik MF, Madsen E, Mamound A, Marres CC, Masselink I, Meerdink M, Menon AG, Mieog JS, Mierlo D, Musters GD, Nieuwenhuijzen GAP, Neijenhuis PA, Nonner J, Oostdijk M, Oosterling SJ, Paul PMP, Peeters KCMJ, Pereboom ITA, Polat F, Poortman P, Raber M, Reiber BMM, Renger RJ, van Rossem CC, Rutten HJ, Rutten A, Schaapman R, Scheer M, Schoonderwoerd L, Schouten N, Schreuder AM, Schreurs WH, Simkens GA, Slooter GD, Sluijmer HCE, Smakman N, Smeenk R, Snijders HS, Sonneveld DJA, Spaansen B, Bilgen EJS, Steller E, Steup WH, Steur C, Stortelder E, Straatman J, Swank HA, Sietses C, Groen HA, Hoeve HG, Riele WW, Thorensen IM, Tip-Pluijm B, Toorenvliet BR, Tseng L, Tuynman JB, van Bastelaar J, van Beek SC, van de Ven AWH, van de Weijer MAJ, van den Berg C, van den Bosch I, van der Bilt JDW, van der Hagen SJ, van der Hul R, van der Schelling G, van der Spek A, van der Wielen N, van Duyn E, van Eekelen C, van Essen JA, van Gangelt K, van Geloven AAW, van Kessel C, van Loon YT, van Rijswijk A, van Rooijen SJ, van Sprundel T, van Steensel L, van Tets WF, van Westreenen HL, Veltkamp S, Verhaak T, Verheijen PM, Versluis-Ossenwaarde L, Vijfhuize S, Vles WJ, Voeten SC, Vogelaar FJ, Vrijland WW, Westerduin E, Westerterp ME, Wetzel M, Wevers KP, Wiering B, Witjes CDM, Wouters MW, Yauw STK, van der Zaag ES, Zeestraten EC, Zimmerman DDE, Zwieten T (2019) Treatment and survival of locally recurrent rectal cancer: a cross-sectional population study 15 years after the Dutch TME trial. Eur J Surg Oncol 45(11):2059–2069

    PubMed  Google Scholar 

  33. Yancy Nou Y, Habiba H, Chang GJ, Rodriguez-Bigas MA, Skibber JM (2011) Prognostic value of quality of life and pain in patients with locally recurrent rectal cancer. Ann Surg Oncol 18(4):989–996

    Google Scholar 

  34. Vermaas M, Ferenschild FTJ, Verhoef C, Nuyttens JJME, Marinelli AWKS, Wiggers T, Kirkels WJ, Eggermont AMM, de Wilt JHW (2007) Total pelvic exenteration for primary locally advanced and locally recurrent rectal cancer. Eur J Surg Oncol 33(4):452–458

    CAS  PubMed  Google Scholar 

  35. Ogunbiyi OA, McKenna K, Birnbaum EH, Fleshman JW, Kodner IJ (1997) Aggressive surgical management of recurrent rectal cancer – is it worthwhile? Dis Colon Rectum 40:150–155

    CAS  PubMed  Google Scholar 

  36. Kusters M, Beets GL, Van de Velde CJH, Beets-Tan RGH, Marijnen CAM, Rutten HJT, Putter H, Moriya Y (2009) A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on patterns of local recurrence. Ann Surg 249(2):229–235

    PubMed  Google Scholar 

  37. Mori T, Takahashi K, Yasuno M (1998) Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbeck's Arch Surg 383(6):409–415

    CAS  Google Scholar 

  38. Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92(6):756–763

    CAS  PubMed  Google Scholar 

  39. De Pablos JO, Mayol J (2019) Controversies in the management of lateral pelvic lymph nodes in patients with advanced rectal cancer: east or west? Front Surg 6:79

    Google Scholar 

  40. Petersen SH, Harling H, Kirkeby LT, Wille-Jørgensen P, Mocellin S (2012) Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev 3:CD004078

    Google Scholar 

  41. Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, Moon SH, Chang HJ, Lim SB, Choi HS, Park JG (2008) Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 15:729–737

    PubMed  Google Scholar 

  42. Ogawa S, Hida J, Ike H, Kinugasa T, Ota M, Shinto E, Itabashi M, Okamoto T, Sugihara K (2016) The important risk factor for lateral pelvic lymph node metastasis of lower rectal cancer is node-positive status on magnetic resonance imaging: study of the lymph node Committee of Japanese Society for Cancer of the Colon and Rectum. Int J Color Dis 31:1719–1728

    Google Scholar 

  43. Oh HK, Kang SB, Lee SM, Lee SY, Ihn MH, Kim DW, Park JH, Kim YH, Lee KH, Kim JS, Kim JW, Kim JH, Chang TY, Park SC, Sohn DK, Oh JH, Park JW, Ryoo SB, Jeong SY, Park KJ (2014) Neoadjuvant chemoradiotherapy affects the indications for lateral pelvic node dissection in mid/low rectal cancer with clinically suspected lateral node involvement: a multicenter retrospective cohort study. Ann Surg Oncol 21(7):2280–2287

    PubMed  Google Scholar 

  44. Kim MJ, Chan Park S, Kim TH, Kim DY, Kim SY, Baek JY, Chang HJ, Park JW, Oh JH (2016) Is lateral pelvic node dissection necessary after preoperative chemoradiotherapy for rectal cancer patients with initially suspected lateral pelvic node? Surg. 160(2):366–376

    Google Scholar 

  45. Yang X, Hu T, Gu C, Yang S, Jiang D, Deng X, Wang Z, Zhou Z (2019) The prognostic significance of isolated tumor cells detected within lateral lymph nodes in rectal cancer patients after laparoscopic lateral lymph node dissection. J Laparoendosc Adv Surg Tech A 29:1462–1468

    PubMed  Google Scholar 

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Authors and Affiliations

  1. University College Dublin, Dublin, Ireland

    M. R. Fahy & M. E. Kelly

  2. Trinity College Dublin, Dublin, Ireland

    T. Nugent

  3. Department of Surgery, St Vincent’s University Hospital, Dublin, Ireland

    E. Hannan & D. C. Winter

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  1. M. R. Fahy
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  2. M. E. Kelly
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Fahy, M., Kelly, M.E., Nugent, T. et al. Lateral pelvic lymphadenectomy for low rectal cancer: a META-analysis of recurrence rates. Int J Colorectal Dis 36, 551–558 (2021). https://doi.org/10.1007/s00384-020-03804-7

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