Abstract

Nisha Mallya

Aims: To compare outcomes of total mesorectal excision (TME) with or without lateral pelvic lymph node dissection (LPLD) for
treatment of rectal cancer.
Methods: The electronic data sources were explored to capture all studies comparing TME with and without LPLD in patients
undergoing operation for rectal cancer. Random effects modelling was utilised for the analyses. The uncertainties associated with
varying follow-up periods among the included studies were resolved by analysis of time-to-event outcomes.
Results: Eighteen comparative studies enrolling 6133 patients were eligible. No difference was found between the two groups in
terms of overall survival (OS) at maximum follow up (OR:1.02, P=0.86), 5-year overall survival (OR:1.01, P=0.94;HR: 0.92,P=0.36),
disease-free survival (DFS) at maximum follow up (OR:1.07,P=0.50), 5-year DFS (OR:1.07,P=0.54; HR:1.25, P=0.23), local recurrence
(OR: 1.01, P=0.97), distant recurrence (OR:0.96, P=0.84), and total recurrence (OR:0.97,P=0.82). TME with LPLD resulted in longer
operative time (MD: 116.02,P<0.00001) and higher risks of postoperative complications (OR:1.59, P=0.007), urinary dysfunction
(OR:6.66, P<0.00001), and sexual dysfunction (OR:9.67, P=0.002). The results remained consistent through separate analyses for
randomised trials, observational studies and patients with or without neoadjuvant chemoradiotherapy.
Conclusions: LPLD results in higher risks of postoperative morbidity, urinary dysfunction and sexual dysfunction without improving
the recurrence and survival outcomes in patients undergoing TME for rectal cancer. An expert consensus statement derived from
combination of the nerve-sparing surgical experience from the East and neoadjuvant therapy experience from the West is strongly
recommended to advice the best treatment strategy for management of rectal cancer.