scholarly journals Laparoscopic versus Open Surgery in Lateral Lymph Node Dissection for Advanced Rectal Cancer: A Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Manzhao Ouyang ◽  
Tianyou Liao ◽  
Yan Lu ◽  
Leilei Deng ◽  
Zhentao Luo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Open Surgery ◽  
Meta Analysis ◽  
Advanced Rectal Cancer ◽  
R0 Resection ◽  
Resection Rate ◽  
Lateral Lymph Node ◽  
Oncological Outcomes ◽  
Conventional Open Surgery

Aim. To compare the clinical efficacies between laparoscopic and conventional open surgery in lateral lymph node dissection (LLND) for advanced rectal cancer. Methods. We comprehensively searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data and performed a cumulative meta-analysis. According to inclusion criteria and exclusion criteria, all eligible randomized controlled trials (RCTs) or retrospective or prospective comparative studies assessing the two techniques were included, and then a meta-analysis was performed by using RevMan 5.3 software to assess the difference in clinical and oncological outcomes between the two treatment approaches. Results. Eight studies involving a total of 892 patients were finally selected, with 394 cases in the laparoscopic surgery group and 498 cases in the traditional open surgery group. Compared with the traditional open group, the laparoscopic group had a longer operative time (WMD=81.56, 95% CI (2.09, 142.03), P=0.008), but less intraoperative blood loss (WMD=−452.18, 95% CI (-652.23, -252.13), P<0.00001), shorter postoperative hospital stay (WMD=−5.30, 95% CI (-8.42, -2.18), P=0.0009), and higher R0 resection rate (OR=2.17, 95% CI (1.14, 4.15), P=0.02). There was no significant difference in the incidence of surgical complications between the two groups (OR=0.52, 95% CI (0.26, 1.07), P=0.08). Lateral lymph node harvest, lateral lymph node metastasis, local recurrence, 3-year overall survival, and 3-year disease-free survival did not differ significantly between the two approaches (P>0.05). Conclusion. Laparoscopic LLND has a similar efficacy in oncological outcomes and postoperative complications to the conventional open surgery, with the advantages of reduced intraoperative blood loss, shorter postoperative hospital stay, and higher R0 resection rate, and tumor radical cure is similar to traditional open surgery. Laparoscopic LLND is a safe and feasible surgical approach, and it may be used as a standard procedure in LLND for advanced rectal cancer.

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.

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 ◽  
Dujanand Singh ◽  
Lie Yang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Local Recurrence ◽  
Lymph Node Dissection ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Lower Rectal Cancer ◽  
Node Dissection ◽  
Lateral Lymph Node

Abstract Background: The impact of lateral lymph node dissection (LLND) in locally advanced lower rectal cancer remains controversial. This study is to compare total mesorectal excision (TME) with or without LLND in lower rectal cancer cases of stage II/III.Methods: The electronic databases were systematically searched that compared TME with or without LLND among patients with lower rectal cancer in clinical stage II/III. Subgroup analysis was performed considering neoadjuvant chemoradiotherapy (nCRT). The hazard ratios (HR), relative risk (RR), and weighted mean difference (WMD) were pooled.Results: Twelve studies of 4458 patients of this meta-analysis demonstrate, LLND alone significantly reduced the local recurrence rate of patients who did not receive nCRT (RR 0.71, P=0.004), while the difference was not significant when combined with nCRT (RR 0.70, P=0.36). The analysis shows 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). Whereas 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 these two groups. Statistically, no 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 distal recurrence (RR 0.95, P=0.78) between these two groups regardless of whether nCRT was performed or not.Conclusions: The study shows LLND alone decreases the local recurrence without using nCRT irrespective of the survival advantage in locally advanced lower rectal cancer. The benefit of controlling local recurrence by LLND alone makes us reconsider the usage of nCRT with LLND.Registration: The protocol for this meta-analysis was registered prospectively with PROSPERO (CRD42020135575) on May 16, 2019.

Lateral lymph node dissection after neoadjuvant (chemo)radiotherapy may improve oncological outcomes in Western patients with low rectal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 163-163 ◽  
Author(s):  
Hidde Maarten Kroon ◽  
Songphol Malakorn ◽  
Nagendra N Dudi-Venkata ◽  
Sergei Bedrikovetski ◽  
Jianliang Liu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Dissection ◽  
Local Recurrence Rate ◽  
Lateral Lymph Node Dissection ◽  
Short Axis ◽  
Node Dissection ◽  
Lateral Lymph Node ◽  
Oncological Outcomes

163 Background: In the West, rectal cancer patients with pre-treatment abnormal lateral lymph nodes (LLN) are commonly treated with neoadjuvant (chemo)radiotherapy (n(C)RT) followed by total mesorectal excision (TME). Few centers perform lateral lymph node dissection (LLND) in addition to this, with the aim of improving oncological outcomes. To date, no comparative data are available in Western patients. Methods: An international multi-center cohort study was conducted comparing six centers from the Netherlands and Australia treating patients with abnormal LLN (≥5mm short-axis) with n(C)RT and TME (LLND- group) versus similarly staged patients from a dedicated cancer center in the USA who underwent a LLND in addition to n(C)RT and TME (LLND+ group). Results: Data were available on 169 patients. LLND+ patients (n = 44) consisted of significantly younger and more female patients with higher ASA-scores and ypN-stages compared to LLND- patients (n = 115). LLND+ patients also had a larger median LLN short-axis and were more likely to receive adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the lateral local recurrence rate (LLRR) was 0% for LLND+ vs. 7% for LLND- (p = 0.09) and the local recurrence rate (LRR) was 3% for LLND+ vs. 11% for LLND- (p = 0.13). No significant differences were observed in disease-free survival (DFS, p = 0.94) or overall survival (OS, p = 0.42). Sub-analysis of patients who underwent adjuvant chemotherapy (LLND- patients: n = 35) demonstrated clinically relevant though non-statistically significant trends towards a lower LLRR (0% for LLND+ vs. 6% for LLND-; p = 0.07), LRR (3% for LLND+ vs. 14% for LLND-; p = 0.06), DFS (p = 0.19) and OS (p = 0.17) in favour of the LLND+ group. Conclusions: Lateral lymph node dissection in addition to neoadjuvant (chemo)radiotherapy may improve oncological outcomes in Western patients with low rectal cancer and abnormal lateral lymph nodes.

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