2022 年 30 巻 2 号 p. 106-114
Introduction: The effect of total mesorectal excision with lateral lymph node dissection for advanced lower rectal cancer is controversial. This study aimed to assess the efficacy of total mesorectal excision with lateral lymph node dissection for advanced lower rectal cancer.
Methods: Randomized controlled trials were searched in electronic databases and trial registries until July 2021. Meta-analyses were performed using random-effects models. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence.
Results: Four studies (984 patients) were included in the meta-analysis. Total mesorectal excision with lateral lymph node dissection may result in little to no difference in overall survival (hazard ratio: 1.24, 95% confidence interval: 0.89–1.73, p = 0.21), disease free survival (hazard ratio: 1.11, 95% confidence interval: 0.86–1.43, p = 0.42), and postoperative complication (risk ratio: 1.23, 95% confidence interval: 0.94–1.60, p = 0.13). However, Total mesorectal excision with lateral lymph node dissection probably results in a large reduction in local recurrence (risk ratio: 0.63, 95% confidence interval: 0.41–0.99, p = 0.04).
Conclusions: There is little robust evidence to recommend the relative superiority of total mesorectal excision with lateral lymph node dissection for advanced rectal cancer so further research is necessary to identify the specific populations in which the procedure is recommended.
