侧方淋巴结清扫术可降低局部进展期低位直肠癌在无术前新辅助放化疗情况下的局部复发率：系统评价和荟萃分析。

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.

机构信息

Institute of Digestive Surgery, Sichuan University, Chengdu, Sichuan, China.

Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.

出版信息

World J Surg Oncol. 2020 Nov 23;18(1):304. doi: 10.1186/s12957-020-02078-1.

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.

背景

局部晚期低位直肠癌的侧方淋巴结清扫（LLND）的影响仍存在争议。本研究旨在比较 II/III 期低位直肠癌患者中接受全直肠系膜切除术（TME）加或不加 LLND 的效果。

方法

系统检索比较 II/III 期低位直肠癌患者接受 TME 加或不加 LLND 的电子数据库。对新辅助放化疗（nCRT）进行亚组分析。汇总风险比（HR）、相对危险度（RR）和加权均数差（WMD）。

结果

本荟萃分析共纳入 12 项研究 4458 例患者，结果显示，单独行 LLND 可显著降低未接受 nCRT 治疗的患者的局部复发率（RR 0.71，P = 0.004），而与 nCRT 联合应用时差异无统计学意义（RR 0.70，P = 0.36）。分析显示，行 TME 加 LLND 与手术时间显著延长（WMD 90.73 min，P < 0.001）、术中出血量增加（WMD 303.20 mL，P < 0.001）和术后并发症（RR = 1.35，P = 0.02）有关。然而，两组之间的尿功能障碍（RR 1.44，P = 0.38）、性功能障碍（RR 1.41，P = 0.17）和术后死亡率（RR = 1.52，P = 0.70）相似。统计学上，两组之间的总生存（OS）（HR 0.93，P = 0.62）、无病生存（DFS）（HR 0.99，P = 0.96）、总复发（RR 0.98，P = 0.83）、侧方复发（RR 0.49，P = 0.14）或远端复发（RR 0.95，P = 0.78）无显著差异，无论是否使用 nCRT。