Skip to main content

Advertisement

SpringerLink
Log in

Total mesorectal excision with and without lateral lymph node dissection: a systematic review of the literature

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Treatment of lateral lymph node metastasis in rectal cancer is still under debate. While these nodes are routinely resected by Japanese teams, neoadjuvant radiochemotherapy alone is performed in Western countries. We aimed to systematically report the current literature assessing the overall and disease-free survivals of patients with rectal cancer treated with total mesorectal resection (TME) with or without lateral lymph node dissection (LLND).

Methods

MEDLINE/Pubmed, Embase, Cochrane, and Web of Science were searched from database implementation until 19 January 2019. Studies reporting overall survival or recurrence-free survival in patients with LLND for rectal cancer were included. We excluded studies including patients with recurrent rectal cancer, multivisceral resection, and/or without control group (patients with rectal surgery without LLND).

Results

Eleven studies were included, accounting for a total of 4159 patients. Overall survival ranged between 55.6 and 92.6% for TME with LLND versus 49.2 and 90.2% for TME alone, with one study reporting statistically significant benefit of LLND. Recurrence-free survival ranged between 58.3 and 74.1% for TME with LLND versus 39.5 and 76.5% for TME alone. Two studies showed statistically significant differences between the two strategies, one randomized controlled trial showed improved recurrence-free survival in TME alone group (74.5% versus 74.1% with LLND at 5 years) and one observational retrospective study reported increased recurrence-free survival with more extensive resection (65.4% versus 39.5% without LLND, at 5 years).

Conclusion

Benefits of LLND are not clear and further randomized controlled trials should be performed to determine which strategy would allow improving survival in rectal cancer patients.

Trial registration

The study protocol was registered in PROSPERO prior to study screening (CRD42019123181) and published in September 2019.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin. 65(2):87–108

    Article  PubMed  Google Scholar 

  2. Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K et al (2012) ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol. 23(10):2479–2516

  3. Herold A, Lehur P-A, Matzel K, O’Connel R (2017) Coloproctology, European Manual of Medicine, 2nd edn. Springer

  4. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin. 69(1):7–34

    Article  PubMed  Google Scholar 

  5. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet Lond Engl. 1(8496):1479–1482

    Article  CAS  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  7. Martling A, Holm T, Johansson H, Rutqvist LE, Cedermark B (2001) Stockholm Colorectal Cancer Study Group. The Stockholm II trial on preoperative radiotherapy in rectal carcinoma: long-term follow-up of a population-based study. Cancer. 92(4):896–902

    Article  CAS  PubMed  Google Scholar 

  8. Kusters M, van de Velde CJH, Beets-Tan RGH, Akasu T, Fujita S, Fujida S et al (2009) Patterns of local recurrence in rectal cancer: a single-center experience. Ann Surg Oncol. 16(2):289–296

    Article  CAS  PubMed  Google Scholar 

  9. Takahashi T, Ueno M, Azekura K, Ohta H (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum. 43(10 Suppl):S59–S68

    Article  CAS  PubMed  Google Scholar 

  10. Wang Z, Loh KY, Tan K-Y, Woo EC-H (2012) The role of lateral lymph node dissection in the management of lower rectal cancer. Langenbecks Arch Surg. 397(3):353–361

    Article  PubMed  Google Scholar 

  11. Shimoyama M, Yamazaki T, Suda T, Hatakeyama K (2003) Prognostic significance of lateral lymph node micrometastases in lower rectal cancer: an immunohistochemical study with CAM5.2. Dis Colon Rectum. 46(3):333–339

    Article  PubMed  Google Scholar 

  12. Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y et al (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 23(1):1–34

    Article  PubMed  Google Scholar 

  13. Weiser MR (2018) AJCC 8th Edition: colorectal cancer. Ann Surg Oncol. 25(6):1454–1455

    Article  Google Scholar 

  14. van de Velde CJH, Boelens PG, Borras JM, Coebergh J-W, Cervantes A, Blomqvist L et al (2014) EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer Oxf Engl 1990 50(1):1.e1–1.e34

    Google Scholar 

  15. Kim TH, Jeong S-Y, 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(3):729–737

    Article  Google Scholar 

  16. Ogura A, Akiyoshi T, Nagasaki T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M, Kuroyanagi H (2017) Feasibility of laparoscopic total mesorectal excision with extended lateral pelvic lymph node dissection for advanced lower rectal cancer after preoperative chemoradiotherapy. World J Surg. 41(3):868–875

    Article  PubMed  Google Scholar 

  17. 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(11):1053–1062

    Article  Google Scholar 

  18. Watanabe T, Tsurita G, Muto T, Sawada T, Sunouchi K, Higuchi Y, Komuro Y, Kanazawa T, Iijima T, Miyaki M, Nagawa H (2002) Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery. 132(1):27–33

    Article  Google Scholar 

  19. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  PubMed  Google Scholar 

  20. Meyer J, Christou N, Combescure C, Buchs N, Ris F (2019) Does lateral lymph node dissection for low rectal cancer improve overall survival? Protocol for a systematic review and meta-analysis. Int J Surg Protoc. 17:1–2

    Article  PubMed  Google Scholar 

  21. Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K, Ohue M, Ota M, Akazai Y, Shiozawa M, Yamaguchi T, Bandou H, Katsumata K, Murata K, Akagi Y, Takiguchi N, Saida Y, Nakamura K, Fukuda H, Akasu T, Moriya Y, Colorectal Cancer Study Group of Japan Clinical Oncology Group (2017) Mesorectal excision with or without lateral nymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg. 266(2):201–207

    Article  PubMed  Google Scholar 

  22. 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

    Article  CAS  PubMed  Google Scholar 

  23. Havenga K, Enker WE, Norstein J, Moriya Y, Heald RJ, van Houwelingen HC et al (1999) Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol. 25(4):368–374

  24. Dong X-S, Xu H-T, Yu Z-W, Liu M, Cu B-B, Zhao P et al (2003) Effect of extended radical resection for rectal cancer. World J Gastroenterol. 9(5):970–973

  25. Hasdemir O, Cöl C, Yalçin E, Tunç G, Bilgen K, Kuçukpinar T (2005) Local recurrence and survival rates after extended systematic lymph-node dissection for surgical treatment of rectal cancer. Hepatogastroenterology. 52(62):455–459

    PubMed  Google Scholar 

  26. Shiozawa M, Akaike M, Yamada R, Godai T, Yamamoto N, Saito H et al (2007) Lateral lymph node dissection for lower rectal cancer. Hepatogastroenterology. 54(76):1066–1070

    PubMed  Google Scholar 

  27. Kobayashi H, Mochizuki H, Kato T, Mori T, Kameoka S, Shirouzu K, Sugihara K (2009r) Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum. 52(4):567–576

    Article  PubMed  Google Scholar 

  28. Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Unno T, Kano A, Kuroyanagi H, Oya M, Yamaguchi T, Watanabe T, Muto T (2014) Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol. 21(1):189–196

    Article  PubMed  Google Scholar 

  29. Kim HJ, Choi G-S, Park JS, Park SY, Cho SH, Lee SJ, Kang BW, Kim JG (2017) Optimal treatment strategies for clinically suspicious lateral pelvic lymph node metastasis in rectal cancer. Oncotarget. 8(59):100724–100733

    Article  PubMed  Google Scholar 

  30. Matsuda T, Sumi Y, Yamashita K, Hasegawa H, Yamamoto M, Matsuda Y, Kanaji S, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y (2018) Outcomes and prognostic factors of selective lateral pelvic lymph node dissection with preoperative chemoradiotherapy for locally advanced rectal cancer. Int J Colorectal Dis. 33(4):367–374

    Article  PubMed  Google Scholar 

  31. Kinugasa T, Akagi Y, Shirouzu K (2014) Benefit of lateral lymph node dissection for rectal cancer: long-term analysis of 944 cases undergoing surgery at a single center (1975-2004). Anticancer Res. 34(8):4633–4639

    PubMed  Google Scholar 

  32. Oki E, Shimokawa M, Ando K, Murata A, Takahashi T, Maeda K, Kusumoto T, Munemoto Y, Nakanishi R, Nakashima Y, Saeki H, Maehara Y (2019) Effect of lateral lymph node dissection for mid and low rectal cancer: an ad-hoc analysis of the ACTS-RC (JFMC35-C1) randomized clinical trial. Surgery. 165(3):586–592

    Article  PubMed  Google Scholar 

  33. Ozawa H, Kotake K, Hosaka M, Hirata A, Sugihara K (2016) Impact of lateral pelvic lymph node dissection on the survival of patients with T3 and T4 low rectal cancer. World J Surg. 40(6):1492–1499

    Article  PubMed  Google Scholar 

  34. 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(11):1663–1672

    Article  PubMed  Google Scholar 

  35. Cheng H, Deng Z, Wang Z, Zhang W, Su J (2011) Lateral lymph node dissection with radical surgery versus single radical surgery for rectal cancer: a meta-analysis. Asian Pac J Cancer Prev APJCP. 12(10):2517–2521

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Christophe Combescure (Division of Epidemiology, University Hospitals of Geneva) for his contribution to data acquisition and interpretation.

Author information

Authors and Affiliations

  1. Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, 14, Geneva, Switzerland

    Gregoire Longchamp, Jeremy Meyer, Sotirios Popeskou, Christian Toso, Nicolas C. Buchs & Frédéric Ris

  2. Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Limoges, France

    Niki Christou

  3. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden

    Elin Roos

Authors
  1. Gregoire Longchamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremy Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Niki Christou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sotirios Popeskou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elin Roos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Toso
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nicolas C. Buchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Frédéric Ris
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GL, JM, and NC conceived and designed the study. GL, JM, and NC acquired the data. GL, JM, NC, SP, ER, CT, NB, and FR interpreted the data. GL, JM, NC, SP, ER, CT, NB, and FR contributed to the writing of the manuscript and to its critical revision. GL, JM, NC, SP, ER, CT, NB, and FR approved the final version of the manuscript.

Corresponding author

Correspondence to Jeremy Meyer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

Not applicable

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Code availability

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(PDF 38 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Longchamp, G., Meyer, J., Christou, N. et al. Total mesorectal excision with and without lateral lymph node dissection: a systematic review of the literature. Int J Colorectal Dis 35, 1183–1192 (2020). https://doi.org/10.1007/s00384-020-03623-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-020-03623-w

Keywords

Search

Navigation