Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis
Summary Background Lateral pelvic lymph-node metastases occur in 10–25% of patients with rectal cancer, and are associated with higher local recurrence and reduced survival rates. A meta-analysis was undertaken to assess the value of extended lateral pelvic lymphadenectomy in the operative managemen...
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| description | Summary Background Lateral pelvic lymph-node metastases occur in 10–25% of patients with rectal cancer, and are associated with higher local recurrence and reduced survival rates. A meta-analysis was undertaken to assess the value of extended lateral pelvic lymphadenectomy in the operative management of rectal cancer. Methods We searched Medline, Embase, Ovid, Cochrane Library, and Google Scholar for studies published between 1965 and 2009 that compared extended lymphadenectomy (EL) with standard rectal resection. 20 studies, which included 5502 patients from one randomised, three prospective non-randomised, and 14 retrospective case–control studies published between 1984 and 2009, met our search criteria and were assessed. 2577 patients underwent EL and 2925 underwent non-EL for rectal cancer. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. End-points evaluated included peri-operative outcomes, 5-year survival and recurrence rates. Findings Operating time was significantly longer in the EL group by 76·7 min (95% CI 18·77–134·68; p=0·0096). Intra-operative blood loss was greater in the EL group by 536·5 mL (95% CI 353·7–719·2; p |
| doi_str_mv | 10.1016/S1470-2045(09)70224-4 |
| format | Article |
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A meta-analysis was undertaken to assess the value of extended lateral pelvic lymphadenectomy in the operative management of rectal cancer. Methods We searched Medline, Embase, Ovid, Cochrane Library, and Google Scholar for studies published between 1965 and 2009 that compared extended lymphadenectomy (EL) with standard rectal resection. 20 studies, which included 5502 patients from one randomised, three prospective non-randomised, and 14 retrospective case–control studies published between 1984 and 2009, met our search criteria and were assessed. 2577 patients underwent EL and 2925 underwent non-EL for rectal cancer. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. End-points evaluated included peri-operative outcomes, 5-year survival and recurrence rates. Findings Operating time was significantly longer in the EL group by 76·7 min (95% CI 18·77–134·68; p=0·0096). Intra-operative blood loss was greater in the EL group by 536·5 mL (95% CI 353·7–719·2; p<0·0001). Peri-operative mortality (OR 0·81, 95% CI 0·34–1·93; p=0·63) and morbidity (OR 1·45, 95% CI 0·89–2·35; p=0·13) were similar between the two groups. Data from individual studies showed that male sexual dysfunction and urinary dysfunction (three studies: OR 3·70, 95% CI 1·66–8·23; p=0·0012) were more prevalent in the EL group. There were no significant differences in 5-year survival (hazard ratio [HR] 1·09, 95% CI 0·78–1·50; p=0·62), 5-year disease-free survival (HR 1·23, 95% CI 0·75–2·03, p=0·41), and local (OR 0·83, 95% CI 0·61–1·13; p=0·23) or distant recurrence (OR 0·93, 95% CI 0·72–1·21; p=0·60). Interpretation Extended lymphadenectomy does not seem to confer a significant overall cancer-specific advantage, but does seem to be associated with increased urinary and sexual dysfunction. Funding The National Institute for Health Research Biomedical Research Centre, London, UK.</description><identifier>ISSN: 1470-2045</identifier><identifier>EISSN: 1474-5488</identifier><identifier>DOI: 10.1016/S1470-2045(09)70224-4</identifier><identifier>PMID: 19767239</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Asian Continental Ancestry Group ; Blood Loss, Surgical ; Colorectal cancer ; Disease-Free Survival ; Erectile dysfunction ; Female ; Hematology, Oncology and Palliative Medicine ; Humans ; Japan ; Lymph Node Excision - adverse effects ; Lymph Node Excision - methods ; Lymphatic Metastasis ; Lymphatic system ; Male ; Meta-analysis ; Metastasis ; Mortality ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Odds Ratio ; Radiation therapy ; Rectal Neoplasms - ethnology ; Rectal Neoplasms - mortality ; Rectal Neoplasms - secondary ; Rectal Neoplasms - surgery ; Risk Assessment ; Sexual disorders ; Sexual Dysfunction, Physiological - etiology ; Statistical analysis ; Surgeons ; Surgery ; Time Factors ; Treatment Outcome ; Urination Disorders - etiology ; Western World</subject><ispartof>The lancet oncology, 2009-11, Vol.10 (11), p.1053-1062</ispartof><rights>Elsevier Ltd</rights><rights>2009 Elsevier Ltd</rights><rights>Copyright Elsevier Limited Nov 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c498t-545f7e40f61a92300bb1840da9c7356745dcd4a094c268d160f05ffbd218975b3</citedby><cites>FETCH-LOGICAL-c498t-545f7e40f61a92300bb1840da9c7356745dcd4a094c268d160f05ffbd218975b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/200911070?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19767239$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Georgiou, Panagiotis, MD</creatorcontrib><creatorcontrib>Tan, Emile, MRCS</creatorcontrib><creatorcontrib>Gouvas, Nikolaos, MD</creatorcontrib><creatorcontrib>Antoniou, Anthony, FRCS</creatorcontrib><creatorcontrib>Brown, Gina, FRCR</creatorcontrib><creatorcontrib>Nicholls, R John, Prof</creatorcontrib><creatorcontrib>Tekkis, Paris, FRCS</creatorcontrib><title>Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis</title><title>The lancet oncology</title><addtitle>Lancet Oncol</addtitle><description>Summary Background Lateral pelvic lymph-node metastases occur in 10–25% of patients with rectal cancer, and are associated with higher local recurrence and reduced survival rates. A meta-analysis was undertaken to assess the value of extended lateral pelvic lymphadenectomy in the operative management of rectal cancer. Methods We searched Medline, Embase, Ovid, Cochrane Library, and Google Scholar for studies published between 1965 and 2009 that compared extended lymphadenectomy (EL) with standard rectal resection. 20 studies, which included 5502 patients from one randomised, three prospective non-randomised, and 14 retrospective case–control studies published between 1984 and 2009, met our search criteria and were assessed. 2577 patients underwent EL and 2925 underwent non-EL for rectal cancer. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. End-points evaluated included peri-operative outcomes, 5-year survival and recurrence rates. Findings Operating time was significantly longer in the EL group by 76·7 min (95% CI 18·77–134·68; p=0·0096). Intra-operative blood loss was greater in the EL group by 536·5 mL (95% CI 353·7–719·2; p<0·0001). Peri-operative mortality (OR 0·81, 95% CI 0·34–1·93; p=0·63) and morbidity (OR 1·45, 95% CI 0·89–2·35; p=0·13) were similar between the two groups. Data from individual studies showed that male sexual dysfunction and urinary dysfunction (three studies: OR 3·70, 95% CI 1·66–8·23; p=0·0012) were more prevalent in the EL group. There were no significant differences in 5-year survival (hazard ratio [HR] 1·09, 95% CI 0·78–1·50; p=0·62), 5-year disease-free survival (HR 1·23, 95% CI 0·75–2·03, p=0·41), and local (OR 0·83, 95% CI 0·61–1·13; p=0·23) or distant recurrence (OR 0·93, 95% CI 0·72–1·21; p=0·60). Interpretation Extended lymphadenectomy does not seem to confer a significant overall cancer-specific advantage, but does seem to be associated with increased urinary and sexual dysfunction. Funding The National Institute for Health Research Biomedical Research Centre, London, UK.</description><subject>Asian Continental Ancestry Group</subject><subject>Blood Loss, Surgical</subject><subject>Colorectal cancer</subject><subject>Disease-Free Survival</subject><subject>Erectile dysfunction</subject><subject>Female</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Japan</subject><subject>Lymph Node Excision - adverse effects</subject><subject>Lymph Node Excision - methods</subject><subject>Lymphatic Metastasis</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Meta-analysis</subject><subject>Metastasis</subject><subject>Mortality</subject><subject>Neoplasm Recurrence, Local</subject><subject>Neoplasm Staging</subject><subject>Odds Ratio</subject><subject>Radiation therapy</subject><subject>Rectal Neoplasms - ethnology</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - secondary</subject><subject>Rectal Neoplasms - surgery</subject><subject>Risk Assessment</subject><subject>Sexual disorders</subject><subject>Sexual Dysfunction, Physiological - etiology</subject><subject>Statistical analysis</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Urination Disorders - etiology</subject><subject>Western World</subject><issn>1470-2045</issn><issn>1474-5488</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkM1u1TAQRi0EoqXwCKCIDWURGDt2HLMAVVX5kSqxAMTScuwJuCTxrZ1ckbfHubkCqRtWY43OfDM-hDyl8IoCrV9_oVxCyYCLc1AvJTDGS36PnOY2LwVvmvuH94ackEcp3QBQSUE8JCdUyVqySp2S71e_JxwduqJfht1P43BEO4VhKfYY05wKG8Y9jpMPo-mLNMcfGJeiC7GImcsta0aL8U1higEnU5qMLcmnx-RBZ_qET471jHx7f_X18mN5_fnDp8uL69Jy1Uz5UNFJ5NDV1ChWAbQtbTg4o6ysRC25cNZxA4pbVjeO1tCB6LrWMdooKdrqjLzYcncx3M6YJj34ZLHvzYhhTlpWnFIpG8jk8zvkTZhjPjdpBqAoBblCYoNsDClF7PQu-sHERVPQq3d98K5XqRqUPnjXPM89O4bP7YDu39RRdAbebQBmGXuPUSfrMatzfhWpXfD_XfH2ToLt_eit6X_hgunvZ6hOTMMWsmaAOiTw6g-KzaaR</recordid><startdate>20091101</startdate><enddate>20091101</enddate><creator>Georgiou, Panagiotis, MD</creator><creator>Tan, Emile, MRCS</creator><creator>Gouvas, Nikolaos, MD</creator><creator>Antoniou, Anthony, FRCS</creator><creator>Brown, Gina, FRCR</creator><creator>Nicholls, R John, Prof</creator><creator>Tekkis, Paris, FRCS</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>3V.</scope><scope>7RV</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20091101</creationdate><title>Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis</title><author>Georgiou, Panagiotis, MD ; 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A meta-analysis was undertaken to assess the value of extended lateral pelvic lymphadenectomy in the operative management of rectal cancer. Methods We searched Medline, Embase, Ovid, Cochrane Library, and Google Scholar for studies published between 1965 and 2009 that compared extended lymphadenectomy (EL) with standard rectal resection. 20 studies, which included 5502 patients from one randomised, three prospective non-randomised, and 14 retrospective case–control studies published between 1984 and 2009, met our search criteria and were assessed. 2577 patients underwent EL and 2925 underwent non-EL for rectal cancer. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. End-points evaluated included peri-operative outcomes, 5-year survival and recurrence rates. Findings Operating time was significantly longer in the EL group by 76·7 min (95% CI 18·77–134·68; p=0·0096). Intra-operative blood loss was greater in the EL group by 536·5 mL (95% CI 353·7–719·2; p<0·0001). Peri-operative mortality (OR 0·81, 95% CI 0·34–1·93; p=0·63) and morbidity (OR 1·45, 95% CI 0·89–2·35; p=0·13) were similar between the two groups. Data from individual studies showed that male sexual dysfunction and urinary dysfunction (three studies: OR 3·70, 95% CI 1·66–8·23; p=0·0012) were more prevalent in the EL group. There were no significant differences in 5-year survival (hazard ratio [HR] 1·09, 95% CI 0·78–1·50; p=0·62), 5-year disease-free survival (HR 1·23, 95% CI 0·75–2·03, p=0·41), and local (OR 0·83, 95% CI 0·61–1·13; p=0·23) or distant recurrence (OR 0·93, 95% CI 0·72–1·21; p=0·60). Interpretation Extended lymphadenectomy does not seem to confer a significant overall cancer-specific advantage, but does seem to be associated with increased urinary and sexual dysfunction. Funding The National Institute for Health Research Biomedical Research Centre, London, UK.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>19767239</pmid><doi>10.1016/S1470-2045(09)70224-4</doi><tpages>10</tpages></addata></record> |
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| subjects | Asian Continental Ancestry Group Blood Loss, Surgical Colorectal cancer Disease-Free Survival Erectile dysfunction Female Hematology, Oncology and Palliative Medicine Humans Japan Lymph Node Excision - adverse effects Lymph Node Excision - methods Lymphatic Metastasis Lymphatic system Male Meta-analysis Metastasis Mortality Neoplasm Recurrence, Local Neoplasm Staging Odds Ratio Radiation therapy Rectal Neoplasms - ethnology Rectal Neoplasms - mortality Rectal Neoplasms - secondary Rectal Neoplasms - surgery Risk Assessment Sexual disorders Sexual Dysfunction, Physiological - etiology Statistical analysis Surgeons Surgery Time Factors Treatment Outcome Urination Disorders - etiology Western World |
| title | Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis |
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