Management of synchronous lateral pelvic nodal metastasis in rectal cancer in the era of neoadjuvant chemoradiation: A systemic review

作     者：Jolene Si Min Wong Grace Hwei Ching Tan Claramae Shulyn Chia Chin-Ann Johnny Ong Melissa Ching Ching Teo 

作者机构：Department of SarcomaPeritoneal and Rare Tumours(SPRinT)Division of Surgery and Surgical OncologyNational Cancer Centre SingaporeSingapore 169610Singapore Duke-NUS Medical School8 College RoadSingapore 169857Singapore Laboratory of Applied Human GeneticsDivision of Medical SciencesNational Cancer Centre SingaporeSingapore 169610Singapore Institute of Molecular and Cell BiologyA*STAR Research Entities61 Biopolis DriveSingapore 138673Singapore 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2020年第12卷第5期

页      面：247-258页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Lateral pelvic lymph node Colorectal cancer Lateral pelvic lymph node dissection 

摘      要：BACKGROUND Lateral pelvic lymph node(LLN)metastasis(LLNM)occur in up to 28%of patients with low rectal tumours.While prophylactic lateral pelvic lymph node dissection(LLND)has been abandoned by most western institutions in the era of neoadjuvant chemoradiation therapy(CRT),the role of selective LLND in patients with enlarged LLN on pre-CRT imaging remains unclear.Some studies have shown improved survival and recurrence outcomes when LLNs showresponseto CRT.However,no management algorithm exists to differentiate treatment forrespondersvsnon-responders.AIM To determine if selective LLND in patients with enlarged LLNs results in improved survival and recurrence outcomes.METHODS A systemic search of Pub Med and Embase databases for studies reporting on patients with synchronous radiologically suspicious LLNM(s-LLNM)in rectal cancer receiving preoperative-CRT was performed.RESULTS Fifteen retrospective,single-centre studies were included.793 patients with sLLNM were evaluated:456 underwent TME while 337 underwent TME with7,LLND post-CRT.In the TME group,local recurrence(LR)rates range from 12.5%to 36%.Five-year disease free survival(DFS)was 42%to 75%.In the TME with LLND group,LR rates were 0%to 6%.Five years DFS was 41.2%to 100%.Radiological response was seen in 58%.Pathologically positive LLN was found in up to 94%of non-responders vs 0%to 20%in responders.Young age,low tumour location and radiological non-response were associated with final positive LLNM and lowered DFS.CONCLUSION LLND is associated with local control in patients with s-LLNM.It can be performed in radiological non-responders given a large majority represent true LLNM.Its role in radiological responders should be considered in selected high risk patients.