Extensive lymph node dissection and overall survival in colon cancer: A systematic review and meta-analysis.

Abstract

e15662 Background: Colon cancer remains a leading cause of cancer-related mortality, with surgical resection and lymph node dissection (LND) being key to recovery treatment. Extensive lymph node dissection (ELND) in enhancing overall survival (OS) remains a subject of ongoing debate, as the evidence regarding its benefits versus associated risks is mixed or inconclusive. This meta-analysis aims to evaluate whether ELND improves OS compared to standard lymph node dissection (SLND) in patients with colon cancer while assessing its impact on perioperative outcomes and lymph node retrieval. Methods: This Systematic Review and Meta-Analysis followed the PRISMA guidelines for evaluating the effectiveness of ELND, which analyzed seven articles containing 3,843 patients diagnosed with primarily local-stage (I-III) colon cancer, which met the inclusion criteria after screening 2797 articles, procured from a rigorous search strategy across bibliographic databases of PubMed, Medline, Pubmed Central, Scopus, Web of Science, and Embase until November 2024. Data analysis was performed using RevMan 5.4 software, which facilitated the computation of risk ratios, mean differences, and 95% confidence intervals (CIs). The assessment of heterogeneity was conducted using I² statistics, while the evaluation of publication bias was carried out through the application of funnel plots. Results: ELND showcased significantly better overall survival rates than SLND with an RR of 0.34; 95% CI: 0.17–0.68; p = 0.002 with no observed heterogeneity (I2 = 0%). However, intraoperative complications between ELND and SLND were similar (RR: 0.90; 95% CI: 0.68–1.19; p = 0.45), although with substantial heterogeneity (I2 = 61%). As expected, given the nature of extensive dissection involved in ELND, it is expected to retrieve more lymph nodes, and statistically, there is an average difference of 10 nodes between the approaches (MD: 10.0; 95% CI: 0.10–10.0; p < 0.0001). However, this outcome exhibited significant heterogeneity (I2 = 100%), likely due to the variations in surgical technique and the definitions of "extensive" dissection in each study included in the analysis. The survival benefit could be attributed to a more thorough removal of Lymph nodes, leading to improved disease staging and subsequent risk assessment and treatment planning. Conclusions: ELND provides promising oncological advantages through improved OS and enhanced staging accuracy without any difference in intraoperative complications. These findings suggest ELND is a valuable technique in colon cancer surgery, specifically for local-stage disease. Further research can focus on having a standardized definition of "extensive dissection" and further validate the study results.