Wong JSM, Tan GHC, Chia CS, Ong CAJ, Teo MCC. Management of synchronous lateral pelvic nodal metastasis in rectal cancer in the era of neoadjuvant chemoradiation: A systemic review. World J Gastrointest Surg 2020; 12(5): 247-258 [PMID: 32551030 DOI: 10.4240/wjgs.v12.i5.247]
Corresponding Author of This Article
Grace Tan Hwei Ching, FRCS (Gen Surg), MBBS, Consultant, MMED (Surg), Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore. gracethc@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Systemic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. May 27, 2020; 12(5): 247-258 Published online May 27, 2020. doi: 10.4240/wjgs.v12.i5.247
Management of synchronous lateral pelvic nodal metastasis in rectal cancer in the era of neoadjuvant chemoradiation: A systemic review
Jolene Si Min Wong, Grace Hwei Ching Tan, Claramae Shulyn Chia, Chin-Ann Johnny Ong, Melissa Ching Ching Teo
Jolene Si Min Wong, Grace Hwei Ching Tan, Claramae Shulyn Chia, Chin-Ann Johnny Ong, Melissa Ching Ching Teo, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
Grace Hwei Ching Tan, Claramae Shulyn Chia, Chin-Ann Johnny Ong, Melissa Ching Ching Teo, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
Chin-Ann Johnny Ong, Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore 169610, Singapore
Chin-Ann Johnny Ong, Institute of Molecular and Cell Biology, A*STAR Research Entities, 61 Biopolis Drive, Singapore 138673, Singapore
Author contributions: Wong JSM was involved in the collection and synthesis of all data and manuscript writing; Tan GHC oversaw the project progress and was involved in the final editing of the manuscript; Chia CS, Ong CAJ and Teo MCC was involved in the editing and reviewing of the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Grace Tan Hwei Ching, FRCS (Gen Surg), MBBS, Consultant, MMED (Surg), Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore. gracethc@gmail.com
Received: December 7, 2019 Peer-review started: December 7, 2019 First decision: December 17, 2019 Revised: March 3, 2020 Accepted: April 28, 2020 Article in press: April 28, 2020 Published online: May 27, 2020 Processing time: 171 Days and 23.7 Hours
Abstract
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 show “response” to CRT. However, no management algorithm exists to differentiate treatment for “responders” vs “non-responders”.
AIM
To determine if selective LLND in patients with enlarged LLNs results in improved survival and recurrence outcomes.
METHODS
A systemic search of PubMed 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 s-LLNM were evaluated: 456 underwent TME while 337 underwent TME with 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.
Core tip: The role of lateral pelvic lymph node (LLN) dissection in rectal cancer patients with synchronous radiologically suspicious LLN is unclear in the era of neoadjuvant chemoradiation. Our systemic review aims to define the role of LLN dissection for patients with synchronous LLNs.
