Lateral Lymph Node Dissection With Radical Surgery Versus Radical Surgery For Rectal Cancer: A Meta-analysis

Objective: A meta-analysis was undertaken to assess the value of Lateral lymph node dissection in the operative management of rectal cancer.Method: A systematic review of lateral lymph node dissection followed by radical surgery was performed by searching the databases including Medline (PubMed),Chinese Biomedical Literature Database for CD-ROM (CBMdisc),Embase, Ovid,Cochrane Library,Google Scholar database search,Foreign Medical Journal Full-Text Service(FMJS). Literature references were checked at the same time. Data including peri-operative outcomes, 5-year survival rates and recurrence rates were extracted from the lateral lymph node dissection arms and the control arms respectively.Using the index of odds ratio or Weighted mean difference to express the result for the categorical variable.Results: 15 studies, which included 4858 patients, met our search criteria and were assessed. 2401 patients underwent LLND and 2457 underwent non-LLND for rectal cancer.Including 1 RCT and 14 CCT. Operating time was significantly longer in the LLND group ( WMD 109.29min , 95%CI 90-128.51 ; P < 0.0001 ) . Intra-operative blood loss was greater in the LLND group(WMD 428.6ml,95%CI 324.7–853.97;P=0.05).Peri-operative morbidity(OR 1.57;95%CI 1.06-2.33;P=0.02)was higher in the LLND groups.Data from individual studies showed that male sexual dysfunction(P<0.05)and urinary dysfunction were more prevalent in the LLND group (three studies: OR 2.90, 95%CI 1.68-5.04;P=0.0001). There were no significant differences in 5-year survival (OR 0.94, 95%CI 0.78-1.12;P=0.48), and recurrence (OR 0.91, 95%CI 0.79-1.05;P=0.19).Conclusion:Lateral lymph node dissection does not seem to confer a significant overall cancer-specific advantage, but does seem to be associated with increased the incidence of urinary dysfunction,sexual dysfunction and perioperative complication.