University of Aberdeen, Aberdeen, Scotland, UK.
Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
Int J Colorectal Dis. 2020 Aug;35(8):1387-1395. doi: 10.1007/s00384-020-03656-1. Epub 2020 Jun 5.
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.
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.
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).
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.
局部晚期低位直肠癌患者中有 15%至 20%发生侧盆淋巴结转移，这增加了新辅助放化疗（nCRT）和全直肠系膜切除术（TME）后局部复发和降低生存率的风险。增加侧盆淋巴结清扫术（LPLND）可能会改善这些患者的预后。本综述旨在确定在常规治疗局部晚期直肠癌的基础上增加 LPLND 是否会带来更好的效果。
我们在 OVID Medline、Cochrane、Clinicaltrials.gov、EMBASE、Clinicaltrialsregister.eu、Web of Knowledge 和 CABAbstracts 上使用以下关键词进行了搜索：“侧盆淋巴结清扫术”、“盆腔淋巴结切除术”、“放化疗”、“直肠癌”、“直肠肿瘤”、“直肠腺癌”和“直肠肿瘤”。如果研究为英文且纳入了接受 nCRT 和直肠切除术±LPLND 的直肠癌患者，则将其纳入研究。主要结局为 3 年和 5 年局部复发率。次要结局为 3 年和 5 年总生存率。
共确定了 6 项研究，纳入了 1210 例接受 nCRT 和 TME 治疗的患者和 268 例接受 nCRT 和直肠切除术加 LPLND 治疗的患者。接受 LPLND 的患者 3 年和 5 年局部复发率较低，但差异无统计学意义（分别为 p = 0.10 和 p = 0.12）。他们的 3 年总生存率较低，但 5 年总生存率较高，差异均无统计学意义（分别为 p = 0.81 和 p = 0.57）。
现有证据表明，与当前的治疗方式相比，LPLND 并不能显著降低局部复发率或提高生存率。需要进一步的研究来确定侧盆淋巴结清扫术在低位直肠癌中的作用。
