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. 2018 Jun;13(2):129-140.
doi: 10.5114/wiitm.2018.75845. Epub 2018 May 16.

Is the laparoscopic approach for rectal cancer superior to open surgery? A systematic review and meta-analysis on short-term surgical outcomes

Piotr Małczak  1   2 , Magdalena Mizera  1 , Grzegorz Torbicz  1 , Jan Witowski  1   2 , Piotr Major  1   2 , Magdalena Pisarska  1   2 , Michał Wysocki  1   2 , Marcin Strzałka  1 , Andrzej Budzyński  1   2 , Michał Pędziwiatr  1   2
Affiliations

Is the laparoscopic approach for rectal cancer superior to open surgery? A systematic review and meta-analysis on short-term surgical outcomes

Piotr Małczak et al. Wideochir Inne Tech Maloinwazyjne. 2018 Jun.

Abstract

Introduction: Over the past years the incidence of colorectal cancers has increased worldwide. Currently it is the most common gastrointestinal malignancy worldwide. The laparoscopic approach has become the gold standard for surgical treatment. However, a recently published meta-analysis showed no difference in short- and long-term oncological outcomes of laparoscopy for treating rectal cancer.

Aim: To assess current literature on short-term outcomes of rectal cancer treatment using laparoscopic surgery in comparison to the open approach.

Material and methods: We performed a systematic review and meta-analysis according to the PRISMA guidelines. The primary outcomes of interest were morbidity and short-term complications.

Results: We identified 4,328 potential references. In the end we included 13 randomized controlled trials (RCTs). We did not find any significant differences in terms of morbidity, haemorrhage, ureter injury, anastomotic leakage, mortality, intra-abdominal abscess or postoperative ileus. We found significant differences in the rate of surgical site infections, operative time, blood loss, length of hospital stay and time to first bowel movement.

Conclusions: This systematic review based on available RCTs confirms that laparoscopic rectal cancer surgery is associated with short-term outcomes comparable to the open approach. Moreover, in some aspects it provides better results (e.g. functional postoperative recovery, lower rate of surgical site infections (SSIs)). The quality of evidence is high; therefore in our opinion it is very unlikely that future trials will alter these results, and for this reason the laparoscopic approach can be considered the gold standard for the treatment of the majority of patients.

Keywords: laparoscopy; rectal cancer; short-term outcomes.

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Figures

Figure 1
Figure 1
Search strategy for OVID
Figure 2
Figure 2
PRISMA flowchart
Figure 3
Figure 3
Risk of bias summary
Figure 4
Figure 4
Pooled estimates of morbidity comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 5
Figure 5
Pooled estimates of intra-operative haemorrhage comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 6
Figure 6
Pooled estimates of ureter injury comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 7
Figure 7
Pooled estimates of anastomotic leakage comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 8
Figure 8
Pooled estimates of mortality comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 9
Figure 9
Pooled estimates of intra-abdominal abscess comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 10
Figure 10
Pooled estimates of surgical site infection comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 11
Figure 11
Pooled estimates of postoperative ileus comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 12
Figure 12
Pooled estimates of operative time comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 13
Figure 13
Pooled estimates of blood loss comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 14
Figure 14
Pooled estimates of length of hospital stay comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
Figure 15
Figure 15
Pooled estimates of time to first bowel movement comparing laparoscopy and open surgery CI – confidence interval, df – degrees of freedom.
See this image and copyright information in PMC

References

    1. Brenner H, Bouvier AM, Foschi R, 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;131:1649–58. - PubMed
    1. van de Velde CJ, Boelens PG, Borras JM, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer. 2014;50:1.e1–34. - PubMed
    1. Monson JR, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised) Dis Colon Rectum. 2013;56:535–50. - PubMed
    1. Keller DS, Qiu J, Senagore AJ. Predicting opportunities to increase utilization of laparoscopy for rectal cancer. Surg Endosc. 2018;32:1556–63. - PubMed
    1. Zhang FW, Zhou ZY, Wang HL, et al. Laparoscopic versus open surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Asian Pac J Cancer Prev. 2014;15:9985–96. - PubMed