Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Feb;1(1):32-47.
doi: 10.1177/2050640612473753.

Laparoscopy for extraperitoneal rectal cancer reduces short-term morbidity: Results of a systematic review and meta-analysis

Alberto Arezzo  1 , Roberto Passera  2 , Gitana Scozzari  1 , Mauro Verra  1 , Mario Morino  1
Affiliations

Laparoscopy for extraperitoneal rectal cancer reduces short-term morbidity: Results of a systematic review and meta-analysis

Alberto Arezzo et al. United European Gastroenterol J. 2013 Feb.

Abstract

Background: The role of laparoscopy in the treatment of extraperitoneal rectal cancer is still controversial. The aim of the study was to evaluate differences in safety of laparoscopic rectal resection for extraperitoneal cancer, compared with open surgery.

Materials and methods: A systematic review from 2000 to July 2012 was performed searching the MEDLINE and EMBASE databases (PROSPERO registration number CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary endpoints were 30-day mortality and morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect.

Results: Eleven studies, representing 1684 patients, met the inclusion criteria: four were randomized for a total of 814 patients. Mortality was observed in 1.2% of patients in the laparoscopic group and in 2.3% of patients in the open group, with an RR of 0.56 (95% CI 0.19-1.64, p = 0.287). The overall incidence of short-term complications was lower in the laparoscopic group (31.5%) compared to the open group (38.2%), with an RR of 0.83 (95% CI 0.73-0.94, p = 0.004). Surgical complications, wound complications, blood loss and the need for blood transfusion, time for bowel movement recovery, food intake recovery, and hospital stay were significantly lower or less frequent in the laparoscopic group. The incidence of intra-operative injuries, anastomotic leakages, and surgical re-interventions was similar in the two groups. Only operative time was in favour of the open group.

Conclusions: Based on the evidence of both randomized and prospective controlled series, mortality was lower after laparoscopy although not significantly so, while the short-term morbidity RR, including subgroup analysis, was significantly lower after laparoscopy for extraperitoneal rectal cancer compared to open surgery.

Keywords: Laparoscopy; meta-analysis; rectal cancer; rectal neoplasms; systematic review.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow-chart diagram detailing the paper selection process.
Figure 2.
Figure 2.
L’Abbé plot for all trials on mortality outcome to investigate potential sources of heterogeneity. Event rate plotted on vertical axis in for laparoscopy group and on horizontal axis for open group; size of circle proportional to number of patients enrolled; solid line represents the overall relative risk line, indicating estimation of relative risk by pooling results of all studies.
Figure 3.
Figure 3.
Forest plot for 30-day mortality. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 4.
Figure 4.
Forest plot for overall 30-day morbidity. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 5.
Figure 5.
Forest plot for 30-day surgical complications. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 6.
Figure 6.
Forest plot for 30-day medical complications. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 7.
Figure 7.
Forest plot for mean operative time. CI, confidence interval; MD, mean difference; W, weight of single study.
Figure 8.
Figure 8.
Forest plot for mean blood loss. CI, confidence interval; MD, mean difference; W, weight of single study.
Figure 9.
Figure 9.
Forest plot for incidence of intra-operative injuries. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 10.
Figure 10.
Forest plot for bowel movement recovery. CI, confidence interval; MD, mean difference; W, weight of single study.
Figure 11.
Figure 11.
Forest plot for food intake recovery. CI, confidence interval; MD, mean difference; W, weight of single study.
Figure 12.
Figure 12.
Forest plot for incidence of blood transfusion. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 13.
Figure 13.
Forest plot for incidence of abdominal abscesses. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 14.
Figure 14.
Forest plot for incidence of wound complications. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 15.
Figure 15.
Forest plot for incidence of anastomotic leakage. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 16.
Figure 16.
Forest plot for incidence of re-intervention. CI, confidence interval; RR, relative risk; W, weight of single study.
Figure 17.
Figure 17.
Forest plot for length of hospital stay. CI, confidence interval; MD, mean difference; W, weight of single study.
See this image and copyright information in PMC

References

    1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991; 1: 144–150 - PubMed
    1. Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359: 2224–2229 - PubMed
    1. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365: 1718–1726 - PubMed
    1. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350: 2050–2059 - PubMed
    1. Veldkamp R, Kuhry E, Hop WC, et al. Colon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005; 6: 477–484 - PubMed