Extended pelvic lymphadenectomy and rectal cancer: An umbrella review

Extended pelvic lymph node dissection (EPLND) for rectal cancer is common in Asian countries to reduce local recurrence and improve survival. This umbrella review investigates the benefit of adding extended lymphadenectomy to the standard total mesorectal excision (TME) practice. We conducted a comprehensive search of PubMed, Scopus, and Web of Science to identify systematic reviews and meta-analyses examining the role of EPLND in rectal cancer surgery. Primary outcomes were local recurrence and overall survival; secondary outcomes included: operation time, blood loss, urinary dysfunction, and sexual dysfunction. Of the 953 articles screened, 12 met the inclusion criteria. The median follow-up time was 52 months. In terms of overall survival, 10 studies found no statistically significant difference in the EPLND group; only two showed a significant improvement in 5-year survival. Nine studies found no significant benefit of EPLND in preventing local recurrence, while two suggested benefits for patients with locally advanced cancer after neoadjuvant chemoradiotherapy. In most studies, operation time and blood loss were higher in the EPLND group. EPLND was associated with increased odds of urinary and sexual dysfunction, with four out of six studies reporting higher rates for both outcomes. Our analysis concludes that EPLND offers no additional benefit over TME alone in terms of local recurrence, overall survival, or secondary outcomes, including increased risks of urinary and sexual dysfunction, longer operation times, and greater blood loss.