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International Journal of Colorectal Disease

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01-11-2021 | Rectal Cancer | Review

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

Authors: Gabriele Anania, Richard Justin Davies, Alberto Arezzo, Francesco Bagolini, Vito D’Andrea, Luigina Graziosi, Salomone Di Saverio, Georgi Popivanov, Isaac Cheruiyot, Roberto Cirocchi, Annibale Donini

Published in: International Journal of Colorectal Disease | Issue 11/2021

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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Title: 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
Authors: Gabriele Anania
Richard Justin Davies
Alberto Arezzo
Francesco Bagolini
Vito D’Andrea
Luigina Graziosi
Salomone Di Saverio
Georgi Popivanov
Isaac Cheruiyot
Roberto Cirocchi
Annibale Donini
Publication date: 01-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Rectal Cancer
Rectal Cancer
Lymphadenectomy
Published in: International Journal of Colorectal Disease / Issue 11/2021
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-021-03946-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Methods

Results

Conclusion

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