Meta-analysis and Systematic Review in Patients with Locally Advanced Rectal Cancer with Total Mesorectal Excision (TME) Alone and TME Combined with Extended Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy
- Author(s)
- Kong, JC; Cribb, BI; Mui, M; Prabhakaran, S; Wang, J; Guerra, GR; Warrier, SK; Heriot, AG;
- Details
- Publication Year 2022-08-01,Volume 84,Issue #4,Page 690-697
- Journal Title
- Indian Journal of Surgery
- Publication Type
- Review
- Abstract
- Locally advanced rectal cancer with lateral pelvic lymph node metastasis connotates a poor prognosis. In the West, neoadjuvant chemoradiotherapy followed by total mesorectal excision (TME) is the standard of care. This paper aimed to assess the oncological outcomes of TME with extended pelvic lymph node dissection (EPLND) following neoadjuvant chemoradiotherapy. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review of the literature until March 2021 was performed. Comparative studies assessing TME versus TME with EPLND were compared, and outcomes were pooled. A total of ten studies met the inclusion criteria. Five studies reported on overall survival (OS), with a statistically significant difference identified between the TME and TME + EPLND (HR 0.66, 95%CI 0.46–0.96, p = 0.032, I2 = 0, p = 0.992). Patients undergoing TME + EPLND were significantly less likely to develop local recurrence (RR 0.43, 95%CI 0.27–0.69, p = < 0.001, I2 = 43.2%, p = 0.070), distant recurrence (RR 0.34, 95%CI 0.18–0.65, p < 0.001, I2 = 77.7%, p < 0.004), and regional recurrence (RR 0.15, 95%CI 0.05–0.42, p < 0 .001, I2 = 22.5%, p = 0.271). Based on the available evidence, TME with EPLND is associated with a statistically significant improvement in 5-year OS, and a reduction in the risk of local, regional, and distant recurrence as compared to TME alone.
- Department(s)
- Surgical Oncology; Laboratory Research
- Publisher's Version
- https://doi.org/10.1007/s12262-021-03127-z
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-12-20 05:36:45
Last Modified: 2024-12-20 05:37:53