Lateral lymph node dissection with radical surgery versus single radical surgery for rectal cancer: a meta-analysis.
OBJECTIVE
To assess the value of lateral lymph node dissection( LLND) in the radical surgery of rectal cancer.


METHODS
The published Chinese and English literature was retrieved. A total of 15 papers fitted the selection criteria, including 4,858 patients. Among them 2,401 were in the LLND group and 2,457 in the non- LLND (NLLND) group. Evaluation parameters included 5-year survival rate recurrence rate, peri-operative outcomes, postoperative urinary and sexual functions.


RESULTS
The operating time was significantly shorter in the NLLND group than that in the LLND group (weighted mean difference (WMD)=109 min, 95 confidence interval(CI):90-129, P <0.001). Intra-operative blood loss was greater in the LLND group, but the difference was not significant (WMD=429 mL, 95 CI:325-854, P = 0.05).The frequency of peri-operative morbidity(OR, 1.57 95 CI:1.06-2.33, P = 0.02) was also significantly higher in the LLND group. There were no significant differences in 5-year survival rate and recurrence rate between the two groups. Data from individual studies(three)showed that the frequency of male urinary dysfunction (OR=5.12, 95CI 2.15-12.19, P=0.0002) and sexual dysfunction (P < 0.05) were greatly lower in the NLLND group.


CONCLUSIONS
Meta analysis showed that LLND did not have specific advantage in decreasing postoperative recurrence and prolonging survival time. Furthermore it was associated with prolonged operation time, increased blood loss and elevated incidence of peri-operative complications and urinary and sexual dysfunction.
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China. doctor_ch@sina.com
Huan
H
Cheng
Zhonglei
Z
Deng
Zeng-jun
ZJ
Wang
Wei
W
Zhang
Jian-tang
JT
Su
D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological; D015996:Survival Rate; D016896:Treatment Outcome; D014549:Urinary Incontinence