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Meta-Analysis
. 2005 Jul 20;2005(3):CD003145.
doi: 10.1002/14651858.CD003145.pub2.

Short term benefits for laparoscopic colorectal resection

W Schwenk  1 , O Haase, J Neudecker, J M Müller
Affiliations
Meta-Analysis

Short term benefits for laparoscopic colorectal resection

W Schwenk et al. Cochrane Database Syst Rev. .

Abstract

Background: Colorectal resections are common surgical procedures all over the world. Laparoscopic colorectal surgery is technically feasible in a considerable amount of patients under elective conditions. Several short-term benefits of the laparoscopic approach to colorectal resection (less pain, less morbidity, improved reconvalescence and better quality of life) have been proposed.

Objectives: This review compares laparoscopic and conventional colorectal resection with regards to possible benefits of the laparoscopic method in the short-term postoperative period (up to 3 months post surgery).

Search strategy: We searched MEDLINE, EMBASE, CancerLit, and the Cochrane Central Register of Controlled Trials for the years 1991 to 2004. We also handsearched the following journals from 1991 to 2004: British Journal of Surgery, Archives of Surgery, Annals of Surgery, Surgery, World Journal of Surgery, Disease of Colon and Rectum, Surgical Endoscopy, International Journal of Colorectal Disease, Langenbeck's Archives of Surgery, Der Chirurg, Zentralblatt für Chirurgie, Aktuelle Chirurgie/Viszeralchirurgie. Handsearch of abstracts from the following society meetings from 1991 to 2004: American College of Surgeons, American Society of Colorectal Surgeons, Royal Society of Surgeons, British Assocation of Coloproctology, Surgical Association of Endoscopic Surgeons, European Association of Endoscopic Surgeons, Asian Society of Endoscopic Surgeons.

Selection criteria: All randomised-controlled trial were included regardless of the language of publication. No- or pseudorandomised trials as well as studies that followed patient's preferences towards one of the two interventions were excluded, but listed separately. RCT presented as only an abstract were excluded.

Data collection and analysis: Results were extracted from papers by three observers independently on a predefined data sheet. Disagreements were solved by discussion. 'REVMAN 4.2' was used for statistical analysis. Mean differences (95% confidence intervals) were used for analysing continuous variables. If studies reported medians and ranges instead of means and standard deviations, we assumed the difference of medians to be equal to the difference of means. If no measure of dispersion was given, we tried to obtain these data from the authors or estimated SD as the mean or median. Data were pooled and rate differences as well as weighted mean differences with their 95% confidence intervals were calculated using random effects models.

Main results: 25 RCT were included and analysed. Methodological quality of most of these trials was only moderate and perioperative treatment was very traditional in most studies. Operative time was longer in laparoscopic surgery, but intraoperative blood was less than in conventional surgery. Intensity of postoperative pain and duration of postoperative ileus was shorter after laparoscopic colorectal resection and pulmonary function was improved after a laparoscopic approach. Total morbidity and local (surgical) morbidity was decreased in the laparoscopic groups. General morbidity and mortality was not different between both groups. Until the 30th postoperative day, quality of life was better in laparoscopic patients. Postoperative hospital stay was less in laparoscopic patients.

Authors' conclusions: Under traditional perioperative treatment, laparoscopic colonic resections show clinically relevant advantages in selected patients. If the long-term oncological results of laparoscopic and conventional resection of colonic carcinoma show equivalent results, the laparoscopic approach should be preferred in patients suitable for this approach to colectomy.

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Conflict of interest statement

None known.

Figures

1
1
1.1
1.1. Analysis
Comparison 1 Patient characteristics, Outcome 1 Female Sex.
1.2
1.2. Analysis
Comparison 1 Patient characteristics, Outcome 2 Age.
2.1
2.1. Analysis
Comparison 2 Operative data, Outcome 1 Operative time.
2.2
2.2. Analysis
Comparison 2 Operative data, Outcome 2 Blood loss.
2.3
2.3. Analysis
Comparison 2 Operative data, Outcome 3 Number of Retrieved Lymphnodes.
2.4
2.4. Analysis
Comparison 2 Operative data, Outcome 4 Length of Specimen.
3.1
3.1. Analysis
Comparison 3 Pain, Outcome 1 Pain Perception.
4.1
4.1. Analysis
Comparison 4 Pulmonary function, Outcome 1 FVC day 1.
4.7
4.7. Analysis
Comparison 4 Pulmonary function, Outcome 7 Day of recovery of 80% FVC.
5.1
5.1. Analysis
Comparison 5 Ileus, Outcome 1 Duration of Postoperative Ileus.
6.1
6.1. Analysis
Comparison 6 Hospital stay, Outcome 1 Postoperative hospital stay.
7.1
7.1. Analysis
Comparison 7 Quality of life, Outcome 1 QLQ‐Scores.
8.1
8.1. Analysis
Comparison 8 Morbidity, Outcome 1 Total Morbidity (General and Local).
9.1
9.1. Analysis
Comparison 9 Local (Surgical) Morbidity, Outcome 1 Local Morbidity (Total).
9.2
9.2. Analysis
Comparison 9 Local (Surgical) Morbidity, Outcome 2 Wound Infection.
9.3
9.3. Analysis
Comparison 9 Local (Surgical) Morbidity, Outcome 3 Intraabdominal Abscess.
9.4
9.4. Analysis
Comparison 9 Local (Surgical) Morbidity, Outcome 4 Anastomotic Insufficiency.
9.5
9.5. Analysis
Comparison 9 Local (Surgical) Morbidity, Outcome 5 Postoperative Ileus.
9.6
9.6. Analysis
Comparison 9 Local (Surgical) Morbidity, Outcome 6 Postoperative bleeding.
9.7
9.7. Analysis
Comparison 9 Local (Surgical) Morbidity, Outcome 7 Fascial disrupture.
9.8
9.8. Analysis
Comparison 9 Local (Surgical) Morbidity, Outcome 8 Reoperation for Complication.
10.1
10.1. Analysis
Comparison 10 General Morbidity, Outcome 1 General Morbidity (Total).
10.2
10.2. Analysis
Comparison 10 General Morbidity, Outcome 2 Pulmonary Morbidity.
10.3
10.3. Analysis
Comparison 10 General Morbidity, Outcome 3 Cardiac Morbidity.
10.4
10.4. Analysis
Comparison 10 General Morbidity, Outcome 4 Urinary tract Morbidity.
10.5
10.5. Analysis
Comparison 10 General Morbidity, Outcome 5 Deep Venous Thrombosis.
10.6
10.6. Analysis
Comparison 10 General Morbidity, Outcome 6 Pulmonary Embolism.
11.1
11.1. Analysis
Comparison 11 Mortality, Outcome 1 Mortality.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD003145

References

References to studies included in this review

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