手术策略之争：局部晚期直肠癌患者临床肿大的侧方淋巴结；扩大直肠系膜切除术（e-TME）与传统手术（单纯TME）的荟萃分析
A battle of surgical strategies: Clinically enlarged lateral lymph nodes in patients with locally advanced rectal cancer; extended mesorectal excision (e-TME) versus traditional surgery (TME-alone) a meta-analysis.
作者信息
Abdelsamad Ahmed, Elsheikh Ahmed, Eltantawy Mahmoud, Othman Ahmed Mohamed, Arif Fariha, Atallah Heba, Elderiny Hind, Zayed Hanaa, Alshal Mai M, Ali Mostafa Maged, Elmorsi Amal H, Rashad Sarah, Elagezy Fatma, Gebauer Florian, Langenbach Mike Ralf, Hamdy Nadia M
机构信息
Deputy head of the oncological surgery department, Section head of robotic surgery, Knappschaft Vest, Hospital, Recklinghausen 45657, Germany; University of Witten/Herdecke, Department of Surgery II, Germany.
Deputy head of the oncological surgery department, Section head of robotic surgery, Knappschaft Vest, Hospital, Recklinghausen 45657, Germany.
出版信息
Pathol Res Pract. 2025 May;269:155874. doi: 10.1016/j.prp.2025.155874. Epub 2025 Mar 7.
BACKGROUND
The infiltration of lateral lymph nodes (LLN) plays a crucial role in the staging and treatment of individuals with locally advanced rectal cancer (LARC). This meta-analysis aimed to compare the efficacy of extended mesorectal excision (eTME) versus traditional mesorectal excision (TME-alone) in patients with clinically enlarged (LLN) concomitant neoadjuvant chemoradiation.
METHODS
This study is registered with PROSPERO (CRD42023457805). A comprehensive literature search was conducted across PubMed/Medline, Scopus, Cochrane Library, EMBASE, Web of Science, and EBSCO databases for comparative studies published until June 2024. The study included patients with clinically enlarged LLN concomitant with neoadjuvant chemoradiation in rectal cancer who underwent either eTME or TME alone. Primary outcomes included local recurrence (LR), lateral local recurrence (LLR), overall survival (OS), distant metastasis, and disease-free survival (DFS).
RESULTS
The pooled mean for LR was 6.6 % in the TME group and 4.8 % in the eTME group, with no significant difference between the groups (OR, 0.569; 95 % CI, 0.180-1.792; P = 0.33). Similarly, the pooled LLR rates were 38.5 % for TME and 55.8 % for eTME, indicating a higher recurrence rate in the eTME group (P = 0.65). In the term of the (OS) rates were 93.7 % for TME and 93.2 % for eTME, with no significant difference (P = 0.56). The (DFS) rates were 84.6 % for TME and 86 % for eTME, with no significant difference (P = 0.38). Additionally, the distant recurrence rates were 6.8 % for TME and 17.5 % for eTME, with no significant difference (P = 0.479).
CONCLUSION
Our meta-analysis provides reliable information on the efficacy of eTME versus TME-alone in patients with clinically enlarged LLN concomitant with nCRT in rectal cancer, as we addressed previous limitations for a more accurate comparison. While the (eTME) does not show significant oncologic benefits over (TME alone), the study emphasizes the need for careful patient selection and further research to refine treatment guidelines. Individual patient- and tumor characteristics should guide the most appropriate surgical strategy.
背景
侧方淋巴结（LLN）浸润在局部晚期直肠癌（LARC）患者的分期和治疗中起着关键作用。本荟萃分析旨在比较扩大直肠系膜切除术（eTME）与单纯传统直肠系膜切除术（TME-alone）在临床肿大的（LLN）并接受新辅助放化疗患者中的疗效。
方法
本研究已在PROSPERO注册（CRD42023457805）。通过对PubMed/Medline、Scopus、Cochrane图书馆、EMBASE、Web of Science和EBSCO数据库进行全面文献检索，以查找截至2024年6月发表的比较研究。该研究纳入了患有临床肿大的LLN并接受新辅助放化疗的直肠癌患者，这些患者接受了eTME或单纯TME。主要结局包括局部复发（LR）、侧方局部复发（LLR）、总生存期（OS）、远处转移和无病生存期（DFS）。
结果
TME组LR的合并均值为6.6%，eTME组为4.8%，两组之间无显著差异（OR，0.569；95%CI，0.180 - 1.792；P = 0.33）。同样，TME的合并LLR率为38.5%，eTME为55.8%，表明eTME组复发率更高（P = 0.65）。在总生存期（OS）方面，TME为93.7%，eTME为93.2%，无显著差异（P = 0.56）。无病生存期（DFS）率TME为84.6%，eTME为86 %，无显著差异（P = 0.38）。此外，远处复发率TME为6.8%，eTME为17.5%，无显著差异（P = 0.479）。
结论
我们的荟萃分析提供了关于eTME与单纯TME在患有临床肿大的LLN并接受nCRT的直肠癌患者中疗效的可靠信息，因为我们解决了先前的局限性以进行更准确的比较。虽然（eTME）与（单纯TME）相比未显示出显著的肿瘤学益处，但该研究强调需要仔细选择患者并进行进一步研究以完善治疗指南。个体患者和肿瘤特征应指导最合适的手术策略。
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