1. Prognostic Value of Lateral Pelvic Lymph Node Dissection for Rectal Cancer: A Meta-Analysis
- Author
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Yang Liu, Leping Li, Hao Wu, Chunyang Zhou, Zhen Fang, Liang Shang, and Fengying Du
- Subjects
medicine.medical_specialty ,Colorectal cancer ,Gastroenterology ,Disease-Free Survival ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Multicenter Studies as Topic ,Lymph node ,Rectal Neoplasms ,business.industry ,Hazard ratio ,Rectum ,Odds ratio ,Prognosis ,medicine.disease ,Total mesorectal excision ,Dissection ,medicine.anatomical_structure ,Meta-analysis ,Lymph Node Excision ,Surgery ,Lymph Nodes ,Neoplasm Recurrence, Local ,business - Abstract
Background and aims The benefit of lateral pelvic lymph node dissection (LPLD) for locally advanced rectal cancer remains controversial. This meta-analysis aimed to evaluate the prognostic value of LPLD in patients with locally advanced rectal cancer. Methods We performed a systematic search in PubMed, Embase, and the Cochrane Library for publications comparing radical resection plus LPLD (LPLD group) with single radical resection (non-LPLD group) for locally advanced rectal cancer. A total of 15 studies satisfied our inclusion criteria and were assessed. Random-effects and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. Results LPLD significantly increased grade 3-4 postoperative complications (odds ratio [OR]1.44, 95% CI 1.03-2.02; P = 0.03) compared with non-LPLD. There were no significant differences in 5-y overall survival (hazard ratio = 0.90, 95% CI 0.77-1.05; P = 0.17), 5-y disease-free survival (hazard ratio 1.12, 95% CI 0.60-2.09; P = 0.73), local recurrence (OR 0.89, 95% CI 0.53-1.51; P = 0.68) or distant recurrence (OR 0.85, 95% CI 0.64-1.12; P = 0.24). Conclusions We found that LPLD significantly increased grade 3-4 postoperative complications but did not increase 5-y overall survival or 5-y disease-free survival compared with single radical resection for locally advanced rectal cancer. Furthermore, it did not decrease the local recurrence or distant recurrence rates. Thus, more multicenter large-scale randomized controlled trials should be conducted to further explore whether the long-term survival benefits of LPLD truly exist.
- Published
- 2021
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