Systemic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background

Up to 28% of patients with locally advanced low rectal cancer present with synchronous lateral pelvic lymph node metastasis (LLNM). While neoadjuvant chemoradiation therapy followed by surgery has become the mainstay of treatment, the role of lateral pelvic lymph node dissection (LLND) remains unclear. As such, our study aims to define its role in patients who present with synchronous LLNM.

Research motivation

An understanding on the optimal management for patients who present with s-LLNM is essential to prevent local recurrence rates. The examination of responders vs non-responders to neoadjuvant chemoradiation can also serve to guide future research to optimise response rates.

Research objectives

We aim to evaluate if there is a difference in recurrence and survival outcomes in patients with s-LLNM post neoadjuvant therapy that is treated with TME only vs TME + LLND. This can serve as a guide to surgeons on the management of such patients.

Research methods

A systemic review was performed for all relevant articles from 1958. To our knowledge, there has been no such review on s-LLNM patients post neoadjuvant chemoradiation therapy.

Research results

Fifteen studies were included. Local recurrence rates was found to be higher in s-LLNM patients who had underwent only TME when compared with those who had additional LLND. True pathological response after neoadjuvant therapy was mixed and an absence of radiological response reflected final pathological findings.

Research conclusions

LLND is associated with local control in patients with s-LLNM. It can be performed in radiological non-responders given that a large majority represent true LLNM. Its role in radiological responders should be considered in selected high risk patients.

Research perspectives

Future research should focus on how to predict pathological non-response after neoadjuvant therapy such that super selective LLND may be performed only in non-responders that are more likely to recur.