scholarly journals Prevalence of Metastatic Lateral Lymph Nodes in Asian Patients with Lateral Lymph Node Dissection for Rectal Cancer: A Meta-analysis

2021 ◽  
Author(s):  
Niki Christou ◽  
Jeremy Meyer ◽  
Christophe Combescure ◽  
Alexandre Balaphas ◽  
Joan Robert-Yap ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Rectal Surgery ◽  
Node Dissection ◽  
Asian Countries ◽  
Mesorectal Excision ◽  
Lateral Lymph Node ◽  
Pooled Prevalence ◽  
Leave One Out

Abstract Importance Rectal cancers occupy the eighth position worldwide for new cases and deaths for both men and women. These cancers have a high tendency to form metastases in the mesorectum but also in the lateral lymph nodes. The therapeutic approach for the involved lateral lymph nodes remains controversial. Objective We performed a systematic review and meta-analysis to assess the prevalence of metastatic lateral lymph nodes in patients with lateral lymph node dissection (LLND) for rectal cancer, which seems to be a fundamental and necessary criterion to discuss any possible indications for LLND. Methods Data sources–study selection–data extraction and synthesis–main outcome and measures. We searched MEDLINE, EMBASE and COCHRANE from November 1, 2018, to November 19, 2018, for studies reporting the presence of metastatic lateral lymph nodes (iliac, obturator and middle sacral nodes) among patients undergoing rectal surgery with LLND. Pooled prevalence values were obtained by random effects models, and the robustness was tested by leave-one-out sensitivity analyses. Heterogeneity was assessed using the Q-test, quantified based on the I2 value and explored by subgroup analyses. Results Our final analysis included 31 studies from Asian countries, comprising 7599 patients. The pooled prevalence of metastatic lateral lymph nodes was 17.3% (95% CI: 14.6–20.5). The inter-study variability (heterogeneity) was high (I2 = 89%). The pooled prevalence was, however, robust and varied between 16.6% and 17.9% according to leave-one-out sensitivity analysis. The pooled prevalence of metastatic lymph nodes was not significantly different when pooling only studies including patients who received neoadjuvant treatment or those without neoadjuvant treatment (p = 0.44). Meta-regression showed that the pooled prevalence was associated with the sample size of studies (p < 0.05), as the prevalence decreased when the sample size increased. Conclusion The pooled prevalence of metastatic lateral lymph nodes was 17.3% among patients who underwent rectal surgery with LLND in Asian countries. Further studies are necessary to determine whether this finding could impact the therapeutic strategy (total mesorectal excision with LLND versus total mesorectal excision with neoadjuvant radiochemotherapy).

Survival benefit of lateral lymph node dissection according to the region of involvement and the number of lateral lymph nodes involved

Surgery Today ◽  
2013 ◽  
Vol 44 (6) ◽  
pp. 1097-1103 ◽  
Author(s):  
Shozo Yokoyama ◽  
Katsunari Takifuji ◽  
Tsukasa Hotta ◽  
Kenji Matsuda ◽  
Takashi Watanabe ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Survival Benefit ◽  
Lateral Lymph Node Dissection ◽  
Node Dissection ◽  
Lateral Lymph Node

scholarly journals Prevalence of Budd-Chiari Syndrome during Pregnancy or Puerperium: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Weirong Ren ◽  
Xiang Li ◽  
Jia Jia ◽  
Yan Xia ◽  
Fengrong Hu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Asian Countries ◽  
Budd Chiari Syndrome ◽  
China National Knowledge Infrastructure ◽  
Common Risk Factor ◽  
Knowledge Infrastructure ◽  
Pooled Prevalence ◽  
Chiari Syndrome ◽  
Huge Variation

Women during pregnancy or puerperium are likely to develop Budd-Chiari syndrome (BCS). However, the reported prevalence of pregnancy-related BCS varied considerably among studies. Our study aims to systematically review this issue. Overall, 817 papers were initially identified via the PubMed, EMBASE, China National Knowledge Infrastructure, and Chinese Scientific and Technological Journal databases. Twenty of them were eligible. The prevalence of pregnancy-related BCS varied from 0% to 21.5%. The pooled prevalence was 6.8% (95% CI: 3.9–10.5%) in all BCS patients, 6.3% (95% CI: 3.8–9.4%) in primary BCS patients, and 13.1% (95% CI: 7.1–20.7%) in female BCS patients. Among them, one study was carried out in Africa with a prevalence of 10.6%; 14 studies in Asian countries with a pooled prevalence of 7.1% (95% CI: 3.1–12.6%); and 5 studies in European countries with a pooled prevalence of 5.0% (95% CI: 3.1–7.3%). The pooled prevalence was 6.7% (95% CI: 2.6–12.3%) in studies published before 2005 and 7.3% (95% CI: 4.2–12.5%) in those published after 2005. In conclusion, pregnancy is a relatively common risk factor for BCS, but there is a huge variation in the prevalence among studies. Physicians should be aware of pregnancy-related BCS.

scholarly journals Report about the clinical meaning of patients with pathologic metastasis of lateral lymph nodes but no metastasis of mesenteric lymph nodes after lateral lymph node dissection in low rectal cancer

2020 ◽  
Author(s):  
Peng Li ◽  
Zhichun Zhang ◽  
Yuanda Zhou ◽  
Qingsheng Zeng ◽  
Xipeng Zhang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Low Rectal Cancer ◽  
Node Dissection ◽  
Lateral Lymph Node ◽  
Node Metastasis ◽  
Mesenteric Lymph

Abstract Purpose The aim of this study is to investigate the clinical significance of lateral lymph node metastasis with no mesenteric lymph node metastasis after lateral lymph node dissection in middle and low rectal cancer .Methods Retrospective analysis was performed on the clinical data of 5 consecutive patients who were pathologically diagnosed with lateral lymph node metastasis, while mesenteric lymph node metastasis was not observed after laparoscopic lateral lymph node dissection underwent for advanced low rectal cancer from July 2017 to August 2019.Results All the 5 patients were successfully completed laparoscopic lateral lymph node dissection, and no cases were transferred to laparotomy.The mean age was 58.80±6.53 years, Two Miles surgeries and three Dixson surgeries were performed.Conclusion We found that some patients had lateral lymph node metastasis, while mesenteric lymph nodes had no metastasis after lateral lymph node dissection.This phenomenon suggests that lateral lymph nodes are one of the important metastasis pathways of low rectal cancer,a new N stage is needed to distinguish it from other types of lymph node metastasis.In addition, LLND is of great significance for the pathological diagnosis of lateral lymph nodes.

scholarly journals Lateral lymph node dissection reduces local recurrence of locally advanced lower rectal cancer in the absence of preoperative neoadjuvant chemoradiotherapy: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Xiang Gao ◽  
Cun Wang ◽  
Yong-Yang Yu ◽  
Lie Yang ◽  
Zong-Guang Zhou
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Local Recurrence ◽  
Meta Analysis ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Lower Rectal Cancer ◽  
Node Dissection ◽  
Lateral Lymph Node

Abstract Background: The role of lateral lymph node dissection (LLND) in the treatment of locally advanced lower rectal cancer remains controversial. The present study was conducted to compare total mesorectal excision (TME) with or without LLND among patients with lower rectal cancer in clinical stage II/III.Methods: PubMed, Embase, Ovid, Cochrane Library, Google Scholar, and the ClinicalTrials.gov databases were systematically searched for publications that compared TME with or without LLND among patients with lower rectal cancer in clinical stage II/III. Subgroup analysis was performed based on whether preoperative neoadjuvant chemoradiotherapy (nCRT) was undertaken. The hazard ratios (HR), relative risk (RR), and weighted mean difference (WMD) were pooled.Results: Twelve studies that included 4458 patients were identified in the current meta-analysis. Collected data demonstrated that TME with LLND was associated with significantly longer operation time (WMD 90.73 min, P<0.001), more intraoperative blood loss (WMD 303.20 mL, P<0.001), and postoperative complications (RR=1.35, P=0.02). Urinary dysfunction (RR 1.44, P=0.38), sexual dysfunction (RR 1.41, P=0.17), and postoperative mortality (RR=1.52, P=0.70) were similar between the two groups. No statistically significant differences were observed in OS (HR 0.93, P=0.62), DFS (HR 0.99, P=0.96), total recurrence (RR 0.98, P=0.83), lateral recurrence (RR 0.49, P=0.14) or distant recurrence (RR 0.95, P=0.78) between the two groups regardless the use of nCRT. LLND significantly reduced local recurrence rate of patients who did not receive nCRT (RR 0.71, P=0.004), while the difference was not significant when nCRT was performed (RR 0.70, P=0.36).Conclusions: Our study found out LLND could not significantly improve survival in locally advanced lower rectal cancer but could reduce the local recurrence in the absence of preoperative nCRT. The advantage of controlling local recurrence might be replaced with nCRT.Registration: The protocol for this meta-analysis was registered prospectively with PROSPERO (CRD42020135575) on May 16, 2019.

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