Prognostic Value of Lateral Pelvic Lymph Node Dissection for Rectal Cancer: A Meta-Analysis

Abstract

The benefit of lateral pelvic lymph node dissection (LPLD) for locally advanced rectal cancer remains controversial. This meta-analysis aimed to evaluate the prognostic value of LPLD in patients with locally advanced rectal cancer. We performed a systematic search in PubMed, Embase, and the Cochrane Library for publications comparing radical resection plus LPLD (LPLD group) with single radical resection (non-LPLD group) for locally advanced rectal cancer. A total of 15 studies satisfied our inclusion criteria and were assessed. Random-effects and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. LPLD significantly increased grade 3-4 postoperative complications (odds ratio [OR]1.44, 95% CI 1.03-2.02; P=0.03) compared with non-LPLD. There were no significant differences in 5-y overall survival (hazard ratio=0.90, 95% CI 0.77-1.05; P=0.17), 5-y disease-free survival (hazard ratio 1.12, 95% CI 0.60-2.09; P=0.73), local recurrence (OR 0.89, 95% CI 0.53-1.51; P=0.68) or distant recurrence (OR 0.85, 95% CI 0.64-1.12; P=0.24). We found that LPLD significantly increased grade 3-4 postoperative complications but did not increase 5-y overall survival or 5-y disease-free survival compared with single radical resection for locally advanced rectal cancer. Furthermore, it did not decrease the local recurrence or distant recurrence rates. Thus, more multicenter large-scale randomized controlled trials should be conducted to further explore whether the long-term survival benefits of LPLD truly exist.