Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Significance, diagnosis and treatment of lateral lymph nodes in rectal cancer : A systematic review

Gulevski, Stephanie LU ; M. Russell, Marcia and Buchwald, Pamela LU (2019) In International Journal of Surgery Open 21. p.73-82
Abstract

Introduction: Patients with low rectal cancer are at risk for lateral lymph node metastasis (LLNM). Neoadjuvant chemoradiotherapy (CRT) is used to eradicate LLNM in the West, whereas in Japan the addition of lateral lymph node dissection (LLND) to total mesorectal excision (TME) is performed. A systematic review was conducted to assess incidence, location, risk factors and diagnosis of LLNM and lateral lymph node (LLN) treatment outcomes. Method: The Medline, Embase and Cochrane databases were searched for English-language articles pertaining to LLNs in rectal cancer. Results: 242 studies were identified and 15 prospective studies selected for qualitative analysis. LLNM was detected in 7–40% of patients who underwent LLND, and lower... (More)

Introduction: Patients with low rectal cancer are at risk for lateral lymph node metastasis (LLNM). Neoadjuvant chemoradiotherapy (CRT) is used to eradicate LLNM in the West, whereas in Japan the addition of lateral lymph node dissection (LLND) to total mesorectal excision (TME) is performed. A systematic review was conducted to assess incidence, location, risk factors and diagnosis of LLNM and lateral lymph node (LLN) treatment outcomes. Method: The Medline, Embase and Cochrane databases were searched for English-language articles pertaining to LLNs in rectal cancer. Results: 242 studies were identified and 15 prospective studies selected for qualitative analysis. LLNM was detected in 7–40% of patients who underwent LLND, and lower incidence occurred in patients without preoperative suspicion of LLNM. LLNs located along the middle rectal artery were most common. LLNM was associated with female sex, advanced T stage and positive mesorectal nodes. LLN short-axis diameter of ≥10 mm on preoperative imaging appeared to predict LLNM after neoadjuvant CRT. The addition of LLND to TME seemed to decrease LR and improve survival rates, with comparable results seen for CRT. LLND appeared to be associated with longer operation time, greater blood loss and increased risk of sexual and urinary dysfunction. Conclusion: LLND could be advantageous for patients with suspected LLNM, but associated morbidities need to be considered. Further studies are needed to improve preoperative identification of LLNs and to determine how to manage persistent enlarged LLNs after CRT. Furthermore, the applicability of LLND in a Western population needs to be investigated.

(Less)
Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chemoradiotherapy, Lateral lymph node dissection, Lateral lymph node metastasis, Outcomes, Rectal cancer
in
International Journal of Surgery Open
volume
21
pages
73 - 82
publisher
Elsevier
external identifiers
  • scopus:85075902251
ISSN
2405-8572
DOI
10.1016/j.ijso.2019.09.001
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2019 The Authors
id
c51d4552-c79e-4d79-96c5-6acce7f5e25a
date added to LUP
2021-10-19 14:04:51
date last changed
2023-03-29 15:58:08
@article{c51d4552-c79e-4d79-96c5-6acce7f5e25a,
  abstract     = {{<p>Introduction: Patients with low rectal cancer are at risk for lateral lymph node metastasis (LLNM). Neoadjuvant chemoradiotherapy (CRT) is used to eradicate LLNM in the West, whereas in Japan the addition of lateral lymph node dissection (LLND) to total mesorectal excision (TME) is performed. A systematic review was conducted to assess incidence, location, risk factors and diagnosis of LLNM and lateral lymph node (LLN) treatment outcomes. Method: The Medline, Embase and Cochrane databases were searched for English-language articles pertaining to LLNs in rectal cancer. Results: 242 studies were identified and 15 prospective studies selected for qualitative analysis. LLNM was detected in 7–40% of patients who underwent LLND, and lower incidence occurred in patients without preoperative suspicion of LLNM. LLNs located along the middle rectal artery were most common. LLNM was associated with female sex, advanced T stage and positive mesorectal nodes. LLN short-axis diameter of ≥10 mm on preoperative imaging appeared to predict LLNM after neoadjuvant CRT. The addition of LLND to TME seemed to decrease LR and improve survival rates, with comparable results seen for CRT. LLND appeared to be associated with longer operation time, greater blood loss and increased risk of sexual and urinary dysfunction. Conclusion: LLND could be advantageous for patients with suspected LLNM, but associated morbidities need to be considered. Further studies are needed to improve preoperative identification of LLNs and to determine how to manage persistent enlarged LLNs after CRT. Furthermore, the applicability of LLND in a Western population needs to be investigated.</p>}},
  author       = {{Gulevski, Stephanie and M. Russell, Marcia and Buchwald, Pamela}},
  issn         = {{2405-8572}},
  keywords     = {{Chemoradiotherapy; Lateral lymph node dissection; Lateral lymph node metastasis; Outcomes; Rectal cancer}},
  language     = {{eng}},
  pages        = {{73--82}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Surgery Open}},
  title        = {{Significance, diagnosis and treatment of lateral lymph nodes in rectal cancer : A systematic review}},
  url          = {{http://dx.doi.org/10.1016/j.ijso.2019.09.001}},
  doi          = {{10.1016/j.ijso.2019.09.001}},
  volume       = {{21}},
  year         = {{2019}},
}