Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People's Republic of China.
World J Surg Oncol. 2023 Jan 31;21(1):28. doi: 10.1186/s12957-023-02908-y.
In patients with colorectal cancer and clinically suspected para-aortic lymph node metastasis, the survival benefit of para-aortic lymphadenectomy is unknown. We conducted a meta-analysis and systematic review to investigate it.
PubMed, Web of Science, and EMBASE were searched until January 2000 to April 2022 to identify studies reporting overall survivals, complication rates, and hazard ratios of prognostic factors in patients with colorectal cancer undergoing para-aortic lymphadenectomy, and those data were pooled.
Twenty retrospective studies (1021 patients undergoing para-aortic lymphadenectomy) met the inclusion criteria. Meta-analysis indicates that participants undergoing para-aortic lymphadenectomy were associated with 5-year survival benefit, compared to those not receiving para-aortic lymphadenectomy (odds ratio = 3.73, 95% confidence interval: 2.05-6.78), but there was no significant difference in complication rate (odds ratio = 0.97, 95% confidence interval: 0.46-2.08). Further analysis of para-aortic lymphadenectomy group showed that 5-year survival of the positive group with pathologically para-aortic lymph node metastasis was lower than that of the negative group (odds ratio = 0.19, 95% confidence interval: 0.11-0.31). Moreover, complete resection (odds ratio = 5.26, 95% confidence interval: 2.02-13.69), para-aortic lymph node metastasis (≤4) (hazard ratio = 1.88, 95% confidence interval: 0.97-3.62), and medium-high differentiation (hazard ratio = 2.98, 95% confidence interval: 1.48-5.99) were protective factors for survival. Preoperative extra-retroperitoneal metastasis was associated with poorer relapse-free survival (hazard ratio = 1.85, 95% confidence interval: 1.10-3.10).
Para-aortic lymphadenectomy had promising clinical efficacy in prolonging survival rather than complication rate in patients with colorectal cancer and clinically diagnostic para-aortic lymph node metastasis. Further prospective studies should be performed.
PROSPERO: CRD42022379276.
对于结直肠癌患者且临床疑似腹主动脉旁淋巴结转移者，腹主动脉旁淋巴结清扫术的生存获益尚不明确。我们进行了一项荟萃分析和系统评价来对此进行研究。
检索 PubMed、Web of Science 和 EMBASE 以确定报道接受腹主动脉旁淋巴结清扫术的结直肠癌患者的总生存、并发症发生率以及预后因素的风险比的研究，检索时间截至 2000 年 1 月至 2022 年 4 月，并对这些数据进行了汇总。
20 项回顾性研究（1021 例接受腹主动脉旁淋巴结清扫术的患者）符合纳入标准。荟萃分析表明，与未接受腹主动脉旁淋巴结清扫术的患者相比，接受腹主动脉旁淋巴结清扫术的患者具有 5 年生存获益（优势比=3.73，95%置信区间：2.05-6.78），但并发症发生率无显著差异（优势比=0.97，95%置信区间：0.46-2.08）。对腹主动脉旁淋巴结清扫术组的进一步分析显示，病理性腹主动脉旁淋巴结转移阳性组的 5 年生存率低于阴性组（优势比=0.19，95%置信区间：0.11-0.31）。此外，完全切除（优势比=5.26，95%置信区间：2.02-13.69）、腹主动脉旁淋巴结转移（≤4 个）（风险比=1.88，95%置信区间：0.97-3.62）和中高分化（风险比=2.98，95%置信区间：1.48-5.99）是生存的保护因素。术前腹膜后转移与无复发生存率较差相关（风险比=1.85，95%置信区间：1.10-3.10）。
对于结直肠癌患者且临床诊断有腹主动脉旁淋巴结转移者，腹主动脉旁淋巴结清扫术在延长生存方面具有良好的临床疗效，而不是增加并发症发生率。应进一步开展前瞻性研究。
PROSPERO：CRD42022379276。
