No advantage in cancer-specific outcome observed with extended lymphadenectomy

Extended lymphadenectomy provided no additional benefit in overall cancer-specific outcome compared with patients who had conventional surgery for rectal cancer.

Researchers searched databases including Medline, Embase, Ovid, Cochrane Library and Google Scholar for studies conducted between 1965 and 2009 that compared extended lymphadenectomy and conventional rectal resection. Findings from one randomized, three prospective and 14 retrospective studies were examined; 2,577 patients had extended lymphadenectomy, and 2,925 patients had conventional surgery.

For perioperative outcomes, operating time was 76.7 minutes longer (P=.0096) for extended lymphadenectomy than for conventional surgery. Intraoperative blood loss was 536.5 mL greater (P<.0001) in extended lymphadenectomy patients also. The mortality rate (P=.63) and overall postoperative morbidity rate (P=.13) were higher in the extended lymphadenectomy patients; however, the difference did not reach statistical significance.

There was no difference between the groups for five-year survival (HR=1.09; 95% CI, 0.78-1.50) or five-year DFS (HR=1.23; 95% CI, 0.75-2.03). No difference was observed between groups for total recurrences including local or distant (HR=0.80; 95% CI, 0.63-1.02).

In addition, data from three studies demonstrated male sexual dysfunction and urinary dysfunction were more common in the group of patients who had extended lymphadenectomy, according to researchers. – by Christen Haigh

Georgiou P. Lancet Oncol. 2009;doi:10.1016/S1470-2045(09)70224-4.

S-1 was shown to be noninferior to infusional 5-FU. Although irinotecan/cisplatin had a higher response rate and the highest one-year survival (12.3 months), there was no statistically significant survival difference between combination chemotherapy compared with single agents (S-1 or 5-FU). The irinotecan/cisplatin arm had significantly more neutropenia and nausea. The majority of patients received second line therapy, crossing over to either S-1 or irinotecan/cisplatin. Given the median time to progression of 2.9 to 4.8 months on first line therapy, it is clear that second line therapy contributed to OS. The study findings indicate that, although first line chemotherapy with irinotecan combination therapy had a higher response, there was no detriment to sequencing single agents followed by combination therapy, with an equivalent OS.

– David Ilson, MD

HemOnc Today Editorial Board member