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Meta-Analysis
. 2017 Aug;21(8):595-604.
doi: 10.1007/s10151-017-1662-4. Epub 2017 Aug 9.

There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes

M Pędziwiatr  1   2 , P Małczak  3   4 , M Mizera  3 , J Witowski  3   4 , G Torbicz  3 , P Major  3   4 , M Pisarska  3   4 , M Wysocki  3   4 , A Budzyński  3   4
Affiliations
Meta-Analysis

There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes

M Pędziwiatr et al. Tech Coloproctol. 2017 Aug.

Abstract

Background: Until recently there has been little data available about long-term outcomes of laparoscopic rectal cancer surgery. But new randomized controlled trials regarding laparoscopic colorectal surgery have been published. The aim of this study was to compare the short- and long-term oncologic outcomes of laparoscopy and open surgery for rectal cancer through a systematic review of the literature and a meta-analysis of relevant RCTs.

Methods: A systematic review of Medline, Embase and the Cochrane library from January 1966 to October 2016 with a subsequent meta-analysis was performed. Only randomized controlled trials with data on circumferential resection margins were included. The primary outcome was the status of circumferential resection margins. Secondary outcomes included lymph node yield, distal resection margins, disease-free and overall survival rates for 3 and 5 years and local recurrence rates.

Results: Eleven studies were evaluated, involving a total of 2018 patients in the laparoscopic group and 1526 patients in the open group. The presence of involved circumferential margins was reported in all studies. There were no statistically significant differences in the number of positive circumferential margins between the laparoscopic group and open group, RR 1.16, 95% CI 0.89-1.50 and no significant differences in involvement of distal margins (RR 1.13 95% CI 0.35-3.66), completeness of mesorectal excision (RR 1.22, 95% CI 0.82-1.82) or number of harvested lymph nodes (mean difference = -0.01, 95% CI -0.89 to 0.87). Disease-free survival rates at 3 and 5 years were not different (p = 0.26 and p = 0.71 respectively), and neither were overall survival rates (p = 0.19 and p = 0.64 respectively), nor local recurrence rates (RR 0.88, 95% CI 0.63-1.23).

Conclusions: Laparoscopic surgery for rectal cancer is associated with similar short-term and long-term oncologic outcomes compared to open surgery. The oncologic quality of extracted specimens seems comparable regardless of the approach used.

Keywords: Circumferential resection margin; Laparoscopy; Local recurrence; Meta-analysis; Rectal cancer; Survival; Total mesorectal excision.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Risk of bias summary
Fig. 3
Fig. 3
Pooled estimates of involved circumferential resection margins comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 4
Fig. 4
Pooled estimates of involved distal margins comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 5
Fig. 5
Pooled estimates of completeness of mesorectal excision comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 6
Fig. 6
Pooled estimates of harvested lymph node yield comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 7
Fig. 7
Pooled estimates of 3-year disease-free survival rate comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 8
Fig. 8
Pooled estimates of 3-year overall survival rate comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 9
Fig. 9
Pooled estimates of 5-year disease-free survival rate comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 10
Fig. 10
Pooled estimates of 5-year overall survival rate comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
Fig. 11
Fig. 11
Pooled estimates of local recurrence rate comparing laparoscopy and open surgery. CI confidence interval, df degrees of freedom, RR risk ratio
See this image and copyright information in PMC

Comment in

  • Nearly complete TME quality conundrum.
    Dyatlov A, Gachabayov M, Bergamaschi R. Dyatlov A, et al. Tech Coloproctol. 2018 Mar;22(3):243. doi: 10.1007/s10151-017-1734-5. Epub 2017 Dec 13. Tech Coloproctol. 2018. PMID: 29236197 No abstract available.
  • Response to: the nearly complete TME quality conundrum.
    Pędziwiatr M, Witowski J, Major P, Małczak P, Mizera M, Budzyński A. Pędziwiatr M, et al. Tech Coloproctol. 2018 Mar;22(3):245-246. doi: 10.1007/s10151-018-1758-5. Epub 2018 Feb 23. Tech Coloproctol. 2018. PMID: 29476445 Free PMC article. No abstract available.

References

    1. Brenner H, Bouvier AM, Foschi R, Hackl M, Larsen IK, Lemmens V, et al. Progress in colorectal cancer survival in Europe from the late 1980s to the early 21st century: the EUROCARE study. Int J Cancer. 2012;131(7):1649–1658. doi: 10.1002/ijc.26192. - DOI - PubMed
    1. van de Velde CJ, Boelens PG, Borras JM, Coebergh JW, Cervantes A, Blomqvist L, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer. 2014;50(1):1.e–e34. - PubMed
    1. Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Rafferty J, et al. Practice parameters for the management of rectal cancer (revised) Dis Colon Rectum. 2013;56(5):535–550. doi: 10.1097/DCR.0b013e31828cb66c. - DOI - PubMed
    1. Askari A, Nachiappan S, Currie A, Bottle A, Athanasiou T, Faiz O. Selection for laparoscopic resection confers a survival benefit in colorectal cancer surgery in England. Surg Endosc. 2016;30(9):3839–3847. doi: 10.1007/s00464-015-4686-8. - DOI - PubMed
    1. Arezzo A, Passera R, Scozzari G, Verra M, Morino M. Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc. 2013;27(5):1485–1502. doi: 10.1007/s00464-012-2649-x. - DOI - PubMed

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