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Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 41-51

Role of lateral pelvic lymph node dissection in rectal cancer: A systematic review and meta-analysis

1 General Surgical Trainee, Liverpool University Hospitals, Liverpool, Glasgow, Scotland, United Kingdom
2 Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
3 Maidstone and Tunbridge Wells Hospital, United Kingdom
4 James Cook University Hospital, United Kingdom
5 North Tees and Hartlepool NHS Foundation Trust, United Kingdom

Correspondence Address:
Dr. Ashwin Rajendiran
General Surgical Trainee, Liverpool University Hospitals, Liverpool
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcs.ijcs_30_20

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Introduction: Total Mesorectal excision (TME) is globally accepted as the standard treatment for rectal cancer. Lateral lymph node dissection (LLND) is still an oncological debate among colorectal surgeons and practiced routinely in some centers of the Eastern world (Japan and Korea) based on limited evidence. Aims: This review aims to determine the oncological and survival benefit of adding LLND to standard TME and also the additional morbidity associated. Outcomes Measured: The primary outcomes are local recurrence, 5-year overall survival and disease-free survival. The secondary outcomes are the incidence of urinary and sexual dysfunction. Materials and Methods: A systematic review protocol was followed. A structured search was run across MEDLINE, OVID, and COCHRANE databases. Five articles from three randomized trials were included. Meta-analysis was performed using Revman 5.3™. Results: No difference was noted between TME and TME + LLND for local recurrence (odds ratio [OR] 0.77, 0.44, 1.35), disease-free survival (OR 1.04, 0.81, 1.34), and overall survival (OR 1.05, 0.79, 1.41). The degree of heterogeneity was within acceptable limits. The OR for urinary dysfunction (OR 2.02, 0.45, 9.11) and male sexual dysfunction (OR 3.96, 0.54, 28.82) had wide confidence intervals and significant heterogeneity; the overall effect was not statistically significant. Conclusion: Our study included only randomized controlled trials and noted no difference in the oncological or survival outcomes. Previous reviews have included nonrandomized studies in a desperate attempt to produce evidence for or against LLND. A carefully arranged International controlled trial is necessary to settle this East-West controversy.

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