A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer

Abstract

The aim of this study was to compare the outcome of the overall complication, mortality, and recurrence rate between laparoscopic resection and open surgery for colorectal cancer. We searched the Medline, Embase, and Cochrane Library and systematically reviewed the randomized controlled trials by comparing the overall complication, mortality, and recurrence rate between laparoscopic resection and open surgery for colorectal cancer. Fifteen trials with 4,207 patients who reported long-term outcomes of the overall complication, mortality, and recurrence rate were included. The combined results of the individual trials showed no statistically significant difference in the odds ratio (OR) for overall recurrence (OR 0.92, 95% CI, 0.77-1.11, P=0.34), local recurrence (OR 0.81, 95% CI, 0.59-1.12, P=0.20), distant metastasis (OR 1.01, 95% CI, 0.78-1.30, P=0.95), wound-site recurrence (OR 1.97, 95% CI, 0.77-5.02, P=0.16), colorectal cancer-related mortality (OR 0.82, 95% CI, 0.66-1.02, P=0.07), colon cancer-related mortality (OR 0.85, 95% CI, 0.66-1.09, P=0.20), rectal cancer-related mortality (OR 0.76, 95% CI, 0.53-1.11, P=0.16), and overall mortality (OR 0.87, 95% CI, 0.73-1.73, P=0.11) between the laparoscopic surgery and open surgery groups. The overall complications in the laparoscopic surgery group were much lower than that in the open surgery group (OR 0.71, 95% CI, 0.58-0.87, P=0.001). This meta-analysis showed that the successful laparoscopic colorectal resection for colorectal cancer was as effective as open surgery in terms of the oncological outcomes, thereby suggesting that laparoscopic surgery can be continued in patients with colorectal cancer.

Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

“…Eight phase III randomized clinical trials 10,11,14-27 and 5 meta-analyses [28][29][30][31][32] comparing laparoscopy and open Table 1). §Only short-term outcomes are published.…”

“…For rectal cancer, 9 phase III randomized clinical trials 11,20,21,[33][34][35][36][37][38][39][40][41][42] and 7 meta-analyses were selected. 28,29,[43][44][45][46][47] No meeting abstracts satisfied the inclusion criteria. The main design characteristics of each randomized trial are summar ized in Table 2 for colon cancer and in Table 3 (Table 1).…”

“…In 2011, Ma and colleagues 29 conducted a meta-analysis comparing laparoscopy with open resection for colorectal cancer. Data from 6 studies (n = 1800) specific to colon cancer showed that cancer-related mortality was 17 …”

“…In the meta-analysis comparing laparoscopy with open resection for colorectal cancer by Ma and colleagues 29 in 2011, data specific to rectal cancer from 5 studies were presented (n = 991). Cancer-related mortality was 13.…”

Specimen Extraction from the Defunctioning Ileostomy Site or Pfannenstiel Incision During Total Laparoscopic Low Anterior Resection for Rectal Cancer

“…However, the oncologic quality of the resected specimen, including the circumferential resection margin and lymph node yield, and long-term oncologic outcomes are similar between laparoscopic and open resection of rectal cancer. [3][4][5] During total laparoscopic rectal cancer surgery, the entire abdominal and pelvic dissection and the division of the distal rectum are performed laparoscopically. After an intracorporeal anastomosis is performed, a small abdominal incision is made that is sufficient for specimen extraction after reinsufflation of the abdomen.…”