Published online May 27, 2020. doi: 10.4240/wjgs.v12.i5.247
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
Processing time: 171 Days and 23.7 Hours
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.
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.
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.
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.
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.
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.
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.