Laparoscopic Versus Conventional Open Surgery in Intersphincteric Resection for Low Rectal Cancer: A Systematic Review and Meta-Analysis

Abstract

Aim: This meta-analysis aims at comparing laparoscopic intersphincteric resection (LISR) with conventional open ISR (OISR) for low rectal cancer (LRC) in terms of intraoperative, postoperative, pathological, and survival outcomes.

Materials and methods: A systematic literature search with no limits was performed in PubMed and Ovid. The last search was performed on May 27, 2017. The outcomes of interests included intraoperative outcomes: operative time and blood loss; postoperative outcomes: hospital day, postoperative hospital day, time to first flatus, time to normal diet, ileus, intra-abdominal abscess, anastomotic leakage, anastomotic stricture, wound infection, pneumonia, urinary complication, morbidity, and mortality; pathological outcomes: lymph node harvested, R0 resection rate, distance of proximal resection margin, distal resection margin and circumferential resection margin (CRM), and positive CRM; survival outcomes: 3-year overall survival (OS), 3-year disease-free survival (DFS), 5-year OS, and 5-year DFS.

Results: Six articles and two abstracts published between 2010 and 2016 were included in our meta-analysis. When compared with OISR, LISR was associated with comparable operative time, less blood loss, shorter length of postoperative hospital day, quick time to first flatus, less incidence of morbidity, and pneumonia. Besides, the two groups were comparable in pathological and survival outcomes.

Conclusions: Our results demonstrated that LISR had comparable operative time, less blood loss and postoperative morbidity, and comparable pathological and survival outcomes when compared with OISR. So LISR was safe and feasible in LRC surgery. Besides, more randomized clinical trials are needed to investigate the deeper effect of LISR in the future.

Keywords: intersphincteric resection; laparoscopic surgery; low rectal cancer; open surgery; outcomes.