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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 8/2020

01-08-2020 | Rectal Cancer | Review

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

Authors: Brendan Zhen Yang Law, Zeneera Yusuf, Yu En Ng, Emad H. Aly

Published in: International Journal of Colorectal Disease | Issue 8/2020

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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.
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Metadata
Title
Does adding lateral pelvic lymph node dissection to neoadjuvant chemotherapy improve outcomes in low rectal cancer?
Authors
Brendan Zhen Yang Law
Zeneera Yusuf
Yu En Ng
Emad H. Aly
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 8/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-020-03656-1

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