Surgery Medical News about Extended lymphadenectomy

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Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis : The Lancet Oncology
The Lancet Oncology - Online First, 10/23/09

Georgiou P et al. – 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.

Methods

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 1 randomised, 3 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

Results

Operating time significantly longer in EL group by 76·7 min
Intra-operative blood loss greater in EL group by 536·5 mL
Peri-operative mortality and morbidity similar between two groups
Data from individual studies showed male sexual dysfunction and urinary dysfunction were more prevalent in EL group
No significant differences in 5-year survival (hazard ratio [HR] 1·09, 95% CI 0·78—1·50), 5-year disease-free survival (HR 1·23, 95% CI 0·75—2·03 ), and local (OR 0·83, 95% CI 0·61—1·13) or distant recurrence (OR 0·93, 95% CI 0·72—1·21)

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