Analysis of patients diagnosed as rectal carcinoma treated with neoadjuvant chemoradiotherapy and radiotherapy alone

14582 Background: Surgery is the standart of the treatment in rectal carcinoma with the help of radiotherapy and chemotherapy applied before or after the operation. Neoadjuvant usage of radiochemotherapy had promising results in randomised trials and in meta-analysis. Methods: We evaluated rectal cancer patients admitted to our center between January 1999-December 2004 retrospectively. Sixty-eight patients were documented. Seventy-five percent of them were male. All of them had adenocarcinoma in histology (19.1% and 5.9% had mucinous and signet ring components respectively). Most of the patients were in Stage II (83.8%). Median 50.4 Gy (45–72 Gy) radiotherapy was delivered in 1.8 Gy fraction dose. Chemoradiotherapy was applied in 86.8% of cases (5-fluorouracil in 35.3% and raltitrexed in 51.5% of them). In operated patients 4 cycle bolus 5-fluorouracil and leucovorin were delivered as adjuvant treatment. Results: Median follow up was 23 months (1–70 months). Downstaging was seen in 54.4 % of cases. In ten (14.7%) patients total response were detected. Six of them (8.8%) were clinically total responders and were not operated. Downstaging was recorded better in 5-fluorouracil group (66.7% versus 37.1%) and it was statistically significant (p< 0.05). Local recurrence and metastasis were seen in 16.2% and 17.6% of the cases respectively. Highest local recurrence rate was seen in T4 stage (42.9%) and highest rate of metastasis was seen in poorly differentiated histology. Regarding all patients; disease free survival and overall survival in three years were 77.7% and 81.4% respectively. There were no statistically significant difference between subgroups of different chemotherapy schedules. Grade I, II and III gastrointestinal system toxicities were seen 16.7%, 48.5% and 15.2% respectively. They were 70.6%, 11.8% when considering Grade I and II hematological toxicities. Conclusions: Neoadjuvant chemoradiotherapy regimens provide downstaging, preserve anal sphincter functions and make easier the surgical approach. In our study 5- fluorouracil seems to be better than raltitrexed but further larger scale randomised trials must be done with different chemotherapeutic agents to state the advantages of neodjuvant chemoradiotherapy in rectal cancer. No significant financial relationships to disclose.

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Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03946-2 ◽

2021 ◽

Author(s):

Gabriele Anania ◽

Richard Justin Davies ◽

Alberto Arezzo ◽

Francesco Bagolini ◽

Vito D’Andrea ◽

...

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Total Mesorectal Excision ◽

Neoadjuvant Therapy ◽

Functional Outcomes ◽

Meta Analysis ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Mesorectal Excision ◽

Timeline Analysis

Abstract The role of lateral lymph node dissection (LLND) during total mesorectal excision (TME) for rectal cancer is still controversial. Many reviews were published on prophylactic LLND in rectal cancer surgery, some biased by heterogeneity of overall associated treatments. The aim of this systematic review and meta-analysis is to perform a timeline analysis of different treatments associated to prophylactic LLND vs no-LLND during TME for rectal cancer. Methods A literature search was performed in PubMed, SCOPUS and WOS for publications up to 1 September 2020. We considered RCTs and CCTs comparing oncologic and functional outcomes of TME with or without LLND in patients with rectal cancer. Results Thirty-four included articles and 29 studies enrolled 11,606 patients. No difference in 5-year local recurrence (in every subgroup analysis including preoperative neoadjuvant chemoradiotherapy), 5-year distant and overall recurrence, 5-year overall survival and 5-year disease-free survival was found between LLND group and non LLND group. The analysis of post-operative functional outcomes reported hindered quality of life (urinary, evacuatory and sexual dysfunction) in LLND patients when compared to non LLND. Conclusion Our publication does not demonstrate that TME with LLND has any oncological advantage when compared to TME alone, showing that with the advent of neoadjuvant therapy, the advantage of LLND is lost. In this review, the most important bias is the heterogeneous characteristics of patients, cancer staging, different neoadjuvant therapy, different radiotherapy techniques and fractionation used in different studies. Higher rate of functional post-operative complications does not support routinely use of LLND.

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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

10.21203/rs.3.rs-42723/v2 ◽

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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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

10.21203/rs.3.rs-42723/v3 ◽

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.

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Addition of Platinum Derivatives to Fluoropyrimidine-Based Neoadjuvant Chemoradiotherapy for Stage II/III Rectal Cancer: Systematic Review and Meta-Analysis

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz081 ◽

2019 ◽

Vol 111 (9) ◽

pp. 887-902 ◽

Cited By ~ 11

Author(s):

Felix J Hüttner ◽

Pascal Probst ◽

Eva Kalkum ◽

Matthes Hackbusch ◽

Katrin Jensen ◽

...

Keyword(s):

Rectal Cancer ◽

Pathological Complete Response ◽

Meta Analysis ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Complete Response ◽

Distant Recurrence ◽

Stage Ii ◽

Free Survival ◽

Disease Free

Abstract Background Current guidelines recommend neoadjuvant therapy for patients with stage II or III rectal cancer. The addition of platinum derivatives to fluoropyrimidine-based chemoradiotherapy has been frequently investigated, but their role in this setting remains controversial. Methods PubMed, Cochrane Library, and Web of Science were systematically searched for randomized trials comparing chemoradiotherapy with or without platinum agents in stage II or III rectal cancer. Main outcome parameters were overall and disease-free survival, additional outcomes included pathological complete response, isolated local recurrence, distant recurrence, toxicity, and perioperative morbidity. Time-to-event data were pooled as hazard ratios (HRs) by the inverse variance method and binary outcomes as odds ratios (ORs) by the Peto method with their respective 95% confidence interval (CI). All statistical tests were two-sided. Results Ten randomized controlled trials with data on 5599 patients were included in the meta-analysis. Platinum derivatives did not statistically significantly improve overall survival (HR = 0.93, 95% CI = 0.82 to 1.05, P = .23), disease-free survival (HR = 0.91, 95% CI = 0.83 to 1.01, P = .07), or local recurrence (OR = 0.83, 95% CI = 0.66 to 1.05, P = .12). However, it led to a statistically significant increase of pathological complete response (OR = 1.31, 95% CI = 1.10 to 1.55, P = .002) and a statistically significant reduction of distant recurrence (OR = 0.78, 95% CI = 0.66 to 0.92, P = .004). Benefits were accompanied by higher rates of grade 3 or 4 toxicities. Conclusions Intensified neoadjuvant chemoradiotherapy with the addition of platinum derivatives cannot be recommended routinely because it did not improve overall or disease-free survival and was associated with increased toxicity. It needs to be elucidated whether the benefits in distant recurrence and pathological complete response may be advantageous for selected high-risk patients.

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Local Recurrence in Patients with Upper Third Rectum Cancer Treated with Surgery Alone Compared with Surgery Plus Chemoradiotherapy

Radiotherapy and Clinical Oncology ◽

10.31487/j.rco.2020.01.03 ◽

2020 ◽

pp. 1-6

Author(s):

Uriel Martinez ◽

Beatriz Mota ◽

David Rayas ◽

Jesús Sansón ◽

Manuel Martínez ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Multimodal Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Rectum Cancer ◽

Historical Cohort ◽

Free Survival ◽

Upper Third ◽

Disease Free

Background: Colorectal cancer is the third most common neoplasm in Mexico, rectal cancer is the 16th most common neoplasm [1]. Due to the different behavior and prognostic factors of locally advance disease, manage should be tailored by a multidisciplinary approach. In tumors that rise in the upper third rectum cancer scenario there are no studies comparing the oncological results of multimodal treatment vs surgery alone. Objective: To compare the disease-free survival in patients with upper third rectal cancer treated with surgery alone vs multimodal treatment. Material and Methods: We conducted a descriptive, retrospective, longitudinal study using an historical cohort. Analysis was based from the information in patient`s records from diagnosed with cancer of the upper third rectum from 2011 to 2016. All patients with diagnosis of upper third rectum cancer were set in to two groups according to the treatment modality recited: Surgery alone and neoadjuvant chemotherapy. The records of patients diagnosed with cancer of the upper third rectum were reviewed and divided into two groups: with and without neoadjuvant chemoradiotherapy, both treated with surgery. Results: A total of 64 patient`s record were eligible, 48 of them were treated with surgery alone and 16 with a multimodal approach. The mean age was 65.5 years in those treated with surgery and 69 in the multimodal management group. The most frequent procedure was anterior resection, 45 cases (70.3%) in the group treated with surgery and 12 cases (18.7%) in the multimodal group. A case of complete pathological response was reported after a follow up of two years. Conclusion: The data suggests that there are no statistically significant differences in the local recurrence and disease-free survival with the use of neoadjuvant chemoradiotherapy.

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Local recurrence and five year survival after abdominoprineal resection of the rectum due to the rectal carcinoma

Acta chirurgica iugoslavica ◽

10.2298/aci0202019k ◽

2002 ◽

Vol 49 (2) ◽

pp. 19-22 ◽

Cited By ~ 1

Author(s):

Zoran Krivokapic ◽

Goran Barisic ◽

V. Markovic ◽

Milos Popovic ◽

Sladjan Antic ◽

...

Keyword(s):

Local Recurrence ◽

Rectal Carcinoma ◽

Disease Free Survival ◽

Free Survival ◽

Cumulative Survival ◽

Significant Difference ◽

Distant Spread ◽

Disease Free ◽

Dukes C

In the period 01.01.1991 - 12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65,2%. In the middle third, there were 28,9% and in the upper, intraperitoneal third 5,9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4,9% cased with Dukes D stage). There were 74,3% males and 23,7% females median age 59,2 years. According to Dukes classification there were 4,9% in stage A, 47,2% in stage B, 43,1% stage C, and 4,9% stage D. There were 4 (2,7%) postoperative deaths. Recurrence of the disease was registered in 44 (30,5%) patients. Local recurrence alone was found in 14 (9,7%) patients, while distant spread was registered in 30 (20,8%) patients. At present, the median follow-up is at 72,9 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 61%, and disease free survival of 63,4% at 60 months of the follow-up. Dukes C is associated with a very poor prognosis; sur-M\al after 60 months of follow up shows cumulative Survival of 0,35 while Dukes B has far better prognosis (0,86). Analysis of disease free survival by Dukes stage shows that Dukes C has the worst prognosis (disease free survival 0,36 after 60 months), while stage B has much better prognosis (0,84). Local recurrence analysis by the Kaplan-Meier's test shows disease free survival of 84,9% at 60 months of follow-up. Analysis of local recurrence by Dukes stage shows 1,00% disease free survival for cases in stage A, 0,94 for Dukes B and 0,66 for Dukes C, while overall comparison between groups regarding local recurrence using the Wilcoxon (Gehan) statistic shows statistically significant difference (p=0,005). There is no statistical difference between Dukes A and Dukes B cases in distribution of local recurrence.

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EP.TU.4973 year oncological outcomes of robotic-assisted versus laparoscopic rectal cancer resections – a single centre experience

British Journal of Surgery ◽

10.1093/bjs/znab311.065 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Lauren O'Connell ◽

Sinead Ramjit ◽

Tim Nugent ◽

Paul Neary ◽

Adnan Hafeez ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Final Analysis ◽

Inclusion Criteria ◽

Recurrence Rates ◽

Robotic Assisted ◽

Oncological Outcomes ◽

Lymph Node Retrieval ◽

Significant Difference

Abstract Background Robotic-assisted minimally invasive surgery (MIS) for rectal cancer is a relatively new technique. Studies to date suggest that short term outcomes including TME quality, margin status, lymph node retrieval and 30-day morbidity and mortality are equivalent in robotic-assisted and laparoscopic MIS for rectal cancer. By contrast, there is a paucity of data on the medium and long-term oncologic safety of robotic-assisted comparative to laparoscopic surgery for rectal cancer. Methods A retrospective review was conducted of all robotic-assisted (n = 31) and laparoscopic (n = 23) rectal cancer cases performed at our institution between January 2016 to December 2018. Inclusion criteria were patients scheduled electively for a laparoscopic or robotic-assisted resection of rectal cancer (anterior resection or abdomino-perineal resection). Patients with distant metastases at presentation, those who proceeded to surgery as an emergency and those with a non-colorectal primary were excluded from analysis. Results A total of 54 (n = 54) cases met the inclusion criteria and were included in the final analysis. The median follow-up was 34 months. Of the 54, 21 patients received neoadjuvant chemoradiotherapy prior to definitive surgery. No significant difference was detected in local recurrence rates (p = 0.5), overall survival (p = 0.7) or disease-free survival (p = 0.8) between the robotic-assisted and laparoscopic cohorts. Conclusion In this series, robotic-assisted rectal cancer resections were associated with equivalent medium term oncological outcomes as laparoscopic procedures. However, given the small numbers in this cohort, outcomes from larger scale datasets will be required to confirm these results.

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A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02415-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Guilin Yu ◽

Wenqing Lu ◽

Zhouguang Jiao ◽

Jun Qiao ◽

Shiyang Ma ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Local Recurrence ◽

Total Mesorectal Excision ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Meta Analysis ◽

Neoadjuvant Chemoradiotherapy ◽

Watch And Wait ◽

Mesorectal Excision

Abstract Background Some clinical researchers have reported that patients with cCR (clinical complete response) status after neoadjuvant chemoradiotherapy (nCRT) could adopt the watch-and-wait (W&W) strategy. Compared with total mesorectal excision (TME) surgery, the W&W strategy could achieve a similar overall survival. Could the W&W strategy replace TME surgery as the main treatment option for the cCR patients? By using the meta-analysis method, we evaluated the safety and efficacy of the W&W strategy and TME surgery for rectal cancer exhibiting cCR after nCRT. Methods We evaluated two treatment strategies for rectal cancer with cCR after nCRT up to July 2021 by searching the Cochrane Library, PubMed, Wanfang, and China National Knowledge Infrastructure (CNKI) databases. Clinical data for primary outcomes (local recurrence, cancer-related death and distant metastasis), and secondary outcomes (disease-free survival (DFS) and overall survival (OS)) were collected to evaluate the efficacy and safety in the two groups. Results We included nine studies with 818 patients in the meta-analysis, and there were five moderate-quality studies and four high-quality studies. A total of 339 patients were in the W&W group and 479 patients were in the TME group. The local recurrence rate in the W&W group was greater than that in the TME group in the fixed-effects model (OR 8.54, 95% CI 3.52 to 20.71, P < 0.001). The results of other outcomes were similar in the two groups. Conclusion The local recurrence rate of the W&W group was greater than that in the TME group, but other results were similar in the two groups. With the help of physical examination and salvage therapy, the W&W strategy could achieve similar treatment effects with the TME approach. Trial registration Protocol registration number: CRD42021244032.

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High-dose neoadjuvant intensity modulated radiotherapy/chemotherapy for distal rectal cancer followed by rectal sparing TEM.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.756 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 756-756

Author(s):

Albert S. DeNittis ◽

Kinjal Parikh ◽

Erik L. Zeger ◽

Gerald J. Marks ◽

John Marks

Keyword(s):

Rectal Cancer ◽

Median Time ◽

Local Excision ◽

Rectal Carcinoma ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

High Dose ◽

Intensity Modulated ◽

Distal Rectal Cancer ◽

Volumetric Arc Therapy

756 Background: In patients with distal rectal cancer, preoperative chemoradiotherapy remains the standard of care, however intensity modulated radiation therapy (IMRT) followed by trans-anal endoscopic microsurgery (TEM) may be able to provide more conformal and higher hoses of radiation while sparing normal tissue. It is our intent to present 11 years of experience of patients treated concurrently with chemotherapy and IMRT followed by rectal sparing TEM. We will report on local control, disease free survival (DFS), and toxicity. Methods: Forty-two patients at Lankenau Medical Center were treated for distal rectal carcinoma with IMRT and TEM from 2004 to 2016. Patients staged T1-T3 N0 M0 received 5580 cGy to the pelvis using a 9 field plan or volumetric arc therapy targeting rectal tumor and pelvic lymph nodes. The median age was 68. All patients received concurrent 5FU based chemotherapy; 54% received an infusional regimen and 46% received oral capecitabine. All patients went on to surgery with full thickness local excision via TEM. 38 underwent surgery within 7-12 weeks following neoadjuvant therapy, with median time to surgery at 11 weeks. Results: Median time to follow up time was 33 months. Complete pathologic response was achieved in 38% (n=17) of patients, good partial response in 53% (n=22), and moderate response in 6%. 4 patients had local recurrence all achieving long term control with salvage surgery. 5 patients developed distant metastasis, most commonly to the liver. Of those, 1 died from metastatic disease, occurring 11 years after initial diagnosis. 79% of patients are currently alive with no evidence of disease. Mean DFS calculated with Kaplan Meier analysis was 88 months with 95% confidence interval between 76 and 101 months. Toxicity was acceptable with only one grade 2 toxicity (diarrhea), and two patients with grade 1 neutropenia. Conclusions: Our 11 year patient experience has shown that neoadjuvant chemoradiotherapy with IMRT followed by TEM is an effective and well tolerated treatment regimen for distal rectal carcinoma. In the appropriately selected patients, local excision surgery may provide an excellent option for patients other than low anterior resection (LAR).

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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

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02078-1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Xiang Gao ◽

Cun Wang ◽

Yongyang 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. Trial registration The protocol for this meta-analysis was registered prospectively with PROSPERO (CRD42020135575) on 16 May 2019.

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