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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

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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.

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CRD42020158946.

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All data will be made available on reasonable request.

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Authors and Affiliations

  1. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Joseph C. Kong, Benjamin I. Cribb, Milton Mui, Glen R. Guerra, Satish K. Warrier & Alexander G. Heriot

  2. Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Joseph C. Kong, Benjamin I. Cribb, Milton Mui, Glen R. Guerra, Satish K. Warrier & Alexander G. Heriot

  3. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia

    Joseph C. Kong, Milton Mui, Glen R. Guerra & Alexander G. Heriot

  4. Department of Colorectal Surgery, Alfred Hospital, Melbourne, VIC, Australia

    Swetha Prabhakaran & Jason Wang

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Contributions

Joseph Kong, Ben Cribb, Alexander Heriot: substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. All authors: substantial contributions to conception and design, interpretation of data, drafting the article or revising it critically for important intellectual content. All authors: final approval of the version to be published.

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Correspondence to Swetha Prabhakaran.

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Joseph C. Kong and Benjamin I. Cribb are co-first authors and have contributed to this manuscript equally

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Kong, J.C., Cribb, B.I., Mui, M. et al. 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. Indian J Surg 84, 690–697 (2022). https://doi.org/10.1007/s12262-021-03127-z

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