Lateral pelvic lymph nodes for rectal cancer: A review of diagnosis and management

Table 1 Studies of magnetic resonance imaging diagnosis and criteria for lateral pelvic lymph node metastasis

Ref.	Patients	Accuracy	Sensitivity	Specificity	PPV	NPV	Criteria
Kim et al[22], 1999	8				12.5%		> 1.2 cm
Kim et al[23], 2000	14				29%		> 10 mm
Arii et al[24], 2006	53	83%	56%	97%	91%	81%	> 7 mm
							Round shape
Matsuoka et al[25], 2007	51	78%	67%	83%			≥ 5 mm (short-axis)
							Ovoid shape
Min et al[26], 2009	66				86.4%		> 1.0 cm, > 0.5 cm (short-axis)
							Spiculated or indistinct borders, mottled heterogenic pattern
Akasu et al[27], 2009	104	87%	87%	87%	52%	97%	≥ 4 mm (short-axis)
Lim et al[28], 2013	67				39.0%		≥ 5 mm (short-axis)
							Spiculated or indistinct border, mottled heterogenic pattern
Akiyoshi et al[29], 2015	77		68%	85%			≥ 8 mm (short-axis)
Ishibe et al[30], 2016	84	88.1%	43.8%	98.5%	87.5%	88.1	≥ 10 mm (short-axis)
Lee et al[33], 2019	37		85.7%	84.0%	12.5%	99.5%	≥ 7 mm (short-axis)
Ogawa et al[35], 2016	268 (right)	77.6%	68.6%	79.7%	44.3%	91.5%	≥ 5 mm (short-axis)
	280 (left)	79.3%	70.8%	81.0%	43.6%	93.1%

NPV: Negative predictive value; PPV: Positive predictive value.

Table 2 Variables in treatment of lateral pelvic lymph node dissection in recent meta-analyses and systematic reviews

Ref.	Study (RCT)	Treatment	Patients	CRT or RT	OS	DFS	TR	LR	LLR
Gao et al[63], 2020	12 (6)	TME + LPLD	1952	359	5-yr HR 0.93, 95%CI: 0.71-1.22, P = 0.62	5-yr HR 0.99, 95%CI: 0.74-1.34, P = 0.96	5-yr RR 0.98, 95%CI: 0.81-1.18, P = 0.83	5-yr RR 0.71, 95%CI: 0.56-0.89, P = 0.003	5-yr RR 0.49, 95%CI: 0.18-1.28, P = 0.14
		TME	2506	1009
Wang et al[64], 2020	16 (4)	TME + LPLD	2984		HR 1.11, 95%CI: 0.77-1.61, P = 0.57	HR 1.05, 95%CI: 0.85-1.30, P = 0.64		OR 0.93, 95%CI: 0.56-1.54, P = 0.78
		TME	3397
Ma et al[65], 2020	26 (5)	TME + LPLD	3171	417	5-yr HR 1.14, 95%CI: 0.85-1.54	5-yr HR 1.07, 95%CI: 0.89-1.28, P = 0.496	OR 1.00, 95%CI: 0.80-1.24	OR 0.90, 95%CI: 0.76-1.06, P = 0.208
		TME	3694	1102
Emile et al[66], 2020	29 (5)	TME + LPLD	4194	551	HR 1.056, 95%CI: 0.98-1.13, P = 0.13	HR 1.02, 95%CI: 0.97-1.07, P = 0.37		HR 0.96, 95%CI: 0.75-1.25, P = 0.79
		TME	6452	1467
Hajibandeh et al[67], 2020	18 (2)	TME + LPLD	2762	321	5-yr OR 1.01, 95%CI: 0.78-1.30, P = 0.94	5-yr OR 1.07, 95%CI: 0.86-1.32, P = 0.54
		TME	3371	735			OR 0.97, 95%CI: 0.72-1.29, P = 0.82	OR 1.01, 95%CI: 0.72-1.42, P = 0.97
Law et al[68], 2020	6 (0)	CRT + TME + LPLD	268	268		5-yr OR 0.70, 95%CI: 0.20-2.39, P = 0.57		5-yr OR 0.42, 95%CI: 0.14-1.24, P = 0.12
		CRT + TME	1210	1210
Yang et al[69], 2020	8 (1)	CRT + TME + LPLD	435	435
		CRT + TME	1461	1461	HR 0.78, 95%CI: 0.32-1.88, P = 0.58	HR 0.94, 95%CI: 0.62-1.43, P = 0.77		OR 0.82, 95%CI: 0.27-2.46, P = 0.72	OR 2.99, 95%CI: 1.20-7.44, P = 0.02

CI: Confidence interval; CRT: Chemoradiation therapy; DFS: Disease-free survival; HR: Hazard ratio; LLR: Local lateral recurrence; LPLD: Lateral pelvic lymph node dissection; LR: Local recurrence; OR: Odds ratio; OS: Overall survival; RCT: Randomized controlled trial; RR: Risk ratio; RT: Radiation therapy; TME: Total mesorectal excision; TR: Total recurrence.

Table 3 Variables in complications of lateral pelvic lymph node dissection in recent meta-analyses and systematic reviews

Ref.	Study (RCT)	Treatment	Patients	CRT or RT	Operation time	Blood loss	Complications	Urinary dysfunction	Sexual dysfunction
Gao et al[63], 2020	12 (6)	TME + LPLD	1952	359	WMD 97.03 min, 95%CI: 75.35-118.72, P < 0.001	WMD 303.20 mL, 95%CI: 156.82-449.58, P < 0.001	RR 1.35, 95%CI: 1.05-1.74, P = 0.02	Pooled RR 1.44, 95%CI: 0.63-3.28, P = 0.38	Pooled RR 1.41, 95%CI: 0.87-2.31, P = 0.17
		TME	2506	1009
Wang et al[64], 2020	16 (4)	TME + LPLD	2984				OR 1.48, 95%CI: 1.07-2.03, P = 0.02	OR 1.60, 95%CI: 0.66-3.87, P = 0.3
		TME	3397
Ma et al[65], 2020	26 (5)	TME + LPLD	417	417	WMD 92.50 min, 95%CI: 75.63-109.37	WMD 283.89 mL, 95%CI: 183.00-384.79	OR 1.30, 95%CI: 1.04-1.63	OR 2.14, 95%CI: 1.21-3.79, P = 0.009	OR 4.19, 95%CI: 1.55-11.33, P = 0.005
		TME	1102	1102
Emile et al[66], 2020	29 (5)	TME + LPLD	4194	551	360 min (median), range 310-540, P = 0.02	582 mL (median), P = 0.4	OR 1.48, 95%CI: 1.18-1.87, P < 0.001	OR 2.1, 95%CI: 1.21-3.67, P = 0.008	OR 1.62, 95%CI: 0.94-2.79, P = 0.08
		TME	6452	1467	294.7 min (median) range 206-480	337 mL (median)
Hajibandeh et al[67], 2020	18 (2)	TME + LPLD	2762	321	MD 116.02, 95%CI: 89.20-142.83, P < 0.00001		OS 1.59, 95%CI: 1.14-2.24, P = 0.007	OR 6.66, 95%CI: 3.31-13.39, P < 0.00001	OR 9.67, 95%CI 2.38-39.26, P = 0.002
		TME	3371	735
Yang et al[69], 2020	8 (1)	CRT + TME + LPLD	435	435
		CRT + TME	1461	1461	MD −138.63 min, 95%CI: −219.66--57.60, P < 0.01	MD −226.24 mL, 95%CI: −505.76-53.27, P = 0.11		OR 0.20, 95%CI: 0.08-0.48, P < 0.01

CI: Confidence interval; CRT: Chemoradiation therapy; LPLD: Lateral pelvic lymph node dissection; MD: Mean difference; OR: Odds ratio; RCT: Randomized controlled trial; RR: Risk ratio; RT: Radiation therapy; TME: Total mesorectal excision; WMD: Weighted mean difference.