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

Table 1 Characteristics of included studies

Ref.	Study period	Study centre	Study Type	Evidence	Intervention	Study sample	Description	Data on RR post CRT
Kim et al[10]	2009-2011	Goyang National Cancer Center, South Korea	Case control	3b	TME	157	Compare outcomes of radio+ vs - LLNM post CRT	Yes
Inoue et al[11]	2001-2013	Mie University Hospital, Tsu, Japan	Case control	3b	TME	19	Compare outcomes of radio+ vs - LLNM patients post CRT	Yes
Kim et al[12]	2001-20091	Goyang National Cancer Center and Seoul National university cancer hospital, South Korea	Case series	4	TME	212	Identify prognostic factors for LLN recurrence in locally advanced rectal ca post CRT	No
MERCURY Study group[18]2	2002-2003	Participating centres in MECURY Group	Case control	3b	TME	38	Compare outcomes of radio+ vs - LLNM patients post CRT	No
Dharnarajan et al[13]	2000-2005	Washington University School of Medicine, United States	Case control	3b	TME	30	Compare outcomes of radio+ vs - LLNM patients post CRT	No
Kim et al[14]	2001-20051	Goyang National Cancer Center, South Korea	Case series	4	TME	64	Identify prognostic factors for LLN recurrence in locally advanced rectal ca post CRT	Yes
Ogura et al[21]	2005-2014	Cancer Institute Hospital, Tokyo, Japan	Case control	3b	TME and LLND	107	Compare laparoscopic TME and LLND for patients with radio+ LLNM vs TME for radio- LLNM based on pre-CRT imaging3	No
Ishihara et al[22]	2003-2015	University of Tokyo, Japan	Case control	3b	TME and LLND	31	Compare TME and LLND for patients with radio+ LLNM and TME for radio- LLNM based on pre-CRT imaging3	Yes
Toshiya et al[23]	1985-20121	Cancer Institute Hospital, Tokyo, Japan	Case control	3b	TME and LLND	30	Evaluate outcomes preopCRT vs no CRT in patients undergoing open TME and LLND	No
Akiyoshi et al[24]	2004-20131	Cancer Institute Hospital, Tokyo, Japan	Case series	3b	TME and LLND	77	Outcomes of TME and LLND for patients with radio+ LLNM based on pre-CRT imaging (MRI)	Yes
Otowa et al[25]	2005 -2013	Kobe University Graduate School of Medicine, Japan	Case series	3b	TME and LLND	10	Outcomes of TME and LLND for patients with radio+ LLNM based on pre-CRT imaging (MRI)	No
Oh et al[26]	2004-2011	(1) Seoul National University Bundang Hospital; (2) Seoul National University Hospital; (3) National Cancer Center, South Korea	Cohort study	2b	TME and LLND	66	Compare outcomes of patients with responsive vs non-responsive LLNM post-CRT who underwent TME and LLND based on pre-CRT imaging of radio+ LLNM	Yes
Akiyoshi et al[27]	2004-20101	Cancer Institute Hospital, Tokyo, Japan	Case control	3b	TME and LLND	38	Compare TME and LLND for patients with radio+ LLNM vs TME for radio- LLNM based on pre-CRT imaging3	No
Liang et al[28]	20102	National Taiwan University Hospital, Taiwan	Case series	4	TME and LLND	34	Outcomes of laparoscopic TME and LLND for patients with radio+ LLNM based on post-CRT imaging	No
Park et al[29]	2003-2009	Kyungpook National University hospital, South Korea	Case series	4	TME and LLND	9	Outcomes of laparoscopic/ robotic TME and LLND for patients with radio+ LLNM based on post-CRT imaging	No

¹Study period not specified.

²Potential overlapping data.

³Additional LLND was performed or patients with radiologically +/enlarged LLN based on pre-CRT imaging. +: Positive; -: Negative; Radio: Radiologically; RR: Radiological response; CRT: Chemoradiation therapy; LLNM: Lateral pelvic lymph node metastases; CRT: Chemoradiation therapy; LLN: Lateral pelvic lymph node; LLND: Lateral pelvic lymph node dissection; TME: Total mesorectal excision; MRI: Magnetic resonance imaging.

Table 2 Outcomes of total mesorectal excision only in suspicious lateral pelvic lymph node metastases

Ref.	Primary surgery	T stage	No. of patients with s-LLNM	No. of “Responders” post CRT	Recurrence	Overall survival	Disease free survival
Kim et al[10]	Sphinc-sav1 83%; sphinc-sac3 17%	All T3/4	157	98 (62%)	LR 15%; SR+LR 6%	5-yr2 85.7%; 5-yr4 74.9%	5-yr2 76.6%; 5-yr4 56.9%
Inoue et al[11]	Sphinc-sav1 63%; sphinc-sac3 37%	All T3/4	19	7 (37%)	3-yr LR 12.5%	5-yr2 84.8%; 5-yr4 72.9%	5-yr2 77.1%; 5-yr4 32.4%
Kim et al[12]	NA	All T2/3/4	212	NA	5-yr LR 36%	5-yr 70.3%5	5-yr 51.4%5
MECURY Study group[18]	NA	T1/2 18%; T3/4 82%	38	NA	NA	NA	5-yr 42%
Dharnarajan et al[13]	Sphinc-sav1 77%; sphinc-sac3 23%	T1/216%; T3/4 83%	30	NA	13%	5-yr 54%	5-yr 42%
Kim et al[14]	Either Sphinc-sav/sac	All T3/4	64	46 (72%)	19.5%2; 44.4%4	NA	NA

¹Sphincter-saving.

²Radiological responder post CRT.

³Sphincter-sacrificing.

⁴Radiological non-responder post CRT.

⁵Average value taken. s-LLNM: Suspicious lateral pelvic lymph node metastases; CRT: Chemoradiation therapy; LR: Local recurrence; SR: Systemic recurrence; NA: Not available.

Table 3 Outcomes of total mesorectal excision and lateral pelvic lymph node dissection in suspicious lateral pelvic lymph node metastases

Ref.	Primary Surgery	T Stage	No. of patients with s-LLNM	No. of “responder” post CRT	No. of pathologic (+) LLN	Morbidity (%)	Recurrence	Overall survival	Disease free survival
Ogura et al[21]	Sphinc-sav1 65%	T2 2%	107	NA	26 (24%)	33.60%	3-yr 3.2%	3-yr 95.8%	3-yr 84.7%
	Sphinc-sac2 35%	T3/4 98%
Ishihara et al[22]	NA	T1/2 42%	31	11 (35%)	1 (9%)3	NA	5-yr 0%	5-yr 81.2%	5-yr 100%
		T3/4 58%			15 (75%)4
Toshiya et al[23]	NA	All T3/4	30	NA	NA	NA	5-yr 3.5%	5-yr 78.2%	5-yr 72.1%
Akiyoshi et al[24]	Sphinc-sav1 61%	T2 1%	77	49 (64%)	10 (20%)3	NA	NA	NA	3-yr3 90%
	Sphinc-sac2 39%	T3/4 99%			21 (75%)4				3-yr4 78%
Otowa et al[25]	NA	All T3/4	10	NA	3 (30%)	NA	NA	NA	NA
Oh et al[26]	Sphinc-sav1 78%	T2 3%	66	30 (45%)	3	43.90%	LR 2%5 5%6	5-yr 58.7%	5-yr 41.2%
	Sphinc-sac2 22%	T3/4 97%			224 (61%)		SR+LR 2%5 27%6	5-yr3 77.1%	5-yr3 72.5%
							SR 16%5 32%6	5-yr4 44.6%	5-yr4 33.7%
Akiyoshi et al[27]	Sphinc-sav1 55%	All T3/T4	38	NA	25 (66%)	36.80%	LR 2.7%	NA	3-yr 83.8%
	Sphinc-sac2 45%
Liang et al[28]	Sphinc-sav1 82%	All T3/T4	34	NA	324 (71%)	20.60%	LR 3%	2-yr4 97.1%	NA
	Sphinc-sac2 18%						SR+LR 3%
							SR 21%
Park et al[29]	Sphinc-sav1 88%	All T3	9	NA	64 (66%)	18.70%	LR 6%	NA	NA
	Sphinc-sac2 12%						SR 13%

¹Sphincter-saving.

²Sphincter-sacrificing.

³Radiological responder post CRT.

⁴Radiological non-responder post CRT.

⁵Pathological responder.

⁶Pathological non-responder. s-LLNM: Suspicious lateral pelvic lymph node metastases; CRT: Chemoradiation therapy; LLN: Lateral pelvic lymph node; LR: Local recurrence; SR: Systemic recurrence; NA: Not available.