Does adding lateral pelvic lymph node dissection to neoadjuvant chemotherapy improve outcomes in low rectal cancer?

Brendan Zhen Yang Law, Zeneera Yusuf*, Yu En Ng, Emad H Aly

*Corresponding author for this work

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

PURPOSE: Lateral pelvic lymph node metastasis occurs in 15 to 20% of patients with locally advanced low rectal cancer which increases risk of local recurrence and reduced survival following neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). Adding lateral pelvic lymph node dissection (LPLND) could improve outcomes in those patients. This review aims to determine if the addition of LPLND to the conventional management of advanced rectal cancer would yield improved outcomes.

METHODS: OVID Medline, Cochrane, Clinicaltrials.gov, EMBASE, Clinicaltrialsregister.eu, Web of Knowledge and CABAbstracts were searched using the following keywords: 'lateral pelvic lymph node dissection', 'pelvis lymphadenectomy', 'chemoradi*', 'rectal cancer', 'rectal neoplasm', 'rectal carcinoma' and 'rectal tumour'. Studies were included if they were in English and included rectal cancer patients that had nCRT, rectal resection ± LPLND. Primary outcome was 3-year and 5-year local recurrence. Secondary outcome was 3-year and 5-year overall survival.

RESULTS: Six studies were identified with 1210 patients who had nCRT and TME, and 268 patients who had nCRT and rectal resection plus LPLND. Patients who had LPLND had non-significant lower 3-year and 5-year local recurrence rate compared with those who did not (p = 0.10 and p = 0.12, respectively). They demonstrated a lower 3-year overall survival but higher 5-year overall survival and both were not significant (p = 0.81 and p = 0.57, respectively).

CONCLUSION: Available evidence suggests that there is no significant reduction in local recurrence rates or improved survival from LPLND to the current treatment modalities. Further studies are required to define the role of lateral pelvic lymph node dissection in low rectal cancer.

Original languageEnglish
Pages (from-to)1387-1395
Number of pages9
JournalInternational Journal of Colorectal Disease
Volume35
Issue number8
Early online date5 Jun 2020
DOIs
Publication statusPublished - Aug 2020

Keywords

  • Lateral pelvic lymph node dissection
  • Pelvis lymphadenectomy
  • chemoradiotherapy
  • rectal cancer
  • Lateral pelvic lymphatic dissection
  • LPLN dissection
  • rectal neoplasm
  • MANAGEMENT
  • METASTASIS
  • Rectal cancer
  • PREOPERATIVE CHEMORADIOTHERAPY
  • Chemoradiotherapy
  • Rectal neoplasm

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