A Meta-analysis of the Short- and Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Conventional Open Surgery for Rectal Cancer

Oda, Hiroshi; Tamamori, Yutaka; Azuma, Takashi; Mori, Yoshihiro; Nishiguchi, Yukio; Maeda, Kiyoshi; Hirakawa, Kosei

doi:10.1007/s11605-011-1547-1

Cited by 93 publications

(87 citation statements)

References 35 publications

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“…Importantly, analysis of the RCTs included in our study indicated that LPS surgery had similar oncological outcomes to open surgery in terms of OS and disease-free survival [6,8,11,12,14]. Moreover, previous meta-analyses also demonstrated that LPS surgery offered equivalent oncological outcomes to open surgery [18][19][20][21][22][23]. Further studies are needed to validate these results.…”

Section: Discussionsupporting

confidence: 58%

Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials

Shen¹,

Yang²,

Zhou³

2017

Immunotherapy

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Aim: This meta-analysis was conducted to evaluate the safety and efficacy of laparoscopic (LPS) versus open surgery for resectable rectal cancer. Methods:We analyzed and compared oncological outcomes, safety outcomes, and recovery outcomes between LPS surgery and open surgery. Meta-analyses were conducted using RevMan 5.3 software. Dichotomous variables were analyzed by risk ratio with 95% confidence intervals, and continuous variables were analyzed as mean differences.Results: A total of 16 randomized controlled trials were identified involving 5386 patients. Based on the currently limited evidence, LPS surgery showed similar oncological outcomes to open surgery in terms of lymph nodes retrieved, positive circumferential resection, incomplete total mesorectal excision, local recurrence, distant metastasis, and unsuccessful resection. LPS surgery was associated with better recovery than open surgery in terms of earlier first bowel movement, earlier start of fluid intake, and shorter hospital stay. However, there was no significant difference in perioperative mortality, re-operation, chest infection, anastomotic leakage, urinary injury, or incision hernia between the LPS and open surgery groups. Importantly, LPS surgery was associated with less intraoperative bleeding, wound infection, and bowel obstruction. Conclusion:Though the overall quality of LPS seems higher than that of open surgery, there is still insufficient evidence to recommend its routine application. However, its similar oncological outcomes, better recovery, and fewer complications suggests that LPS TME may represent a good option for experienced centers or surgeons.

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Section: Discussionsupporting

confidence: 58%

Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials

Shen¹,

Yang²,

Zhou³

2017

Immunotherapy

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“…Consequently, 6 randomized trials presenting data on survival and recurrence were retrieved and showed noninferiority of laparoscopic compared with open resection for rectal cancer in terms of overall and disease-free survival. 20,33,36,37,39,41 The equivalence of these 2 procedures is supported by 3 meta-analyses, [43][44][45] and was confirmed for both anterior and abdominoperineal resections. 20 All trials retrieved included resections of the left, right or sigmoid colon for adult patients with stage I, II or III colon cancer or anterior or abdominoperineal resection of rectal cancer of any stage.…”

Section: Oncologic Outcomesmentioning

confidence: 84%

“…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).…”

Section: Researchmentioning

confidence: 99%

“…Three-year overall survival (p = 0.11, 4 trials) and disease-free survival (p = 0.11, 3 trials) were not significantly different after 44 conduted a metaanalysis comparing the oncologic efficacy of laparoscopic and open surgery for rectal cancer. Twelve trials were included (n = 2095), and results showed no difference between the 2 procedures for the oncologic outcomes measured (Table 4).…”

Section: Meta-analysesmentioning

confidence: 99%

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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

et al. 2013

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Background: Adoption of the laparoscopic approach for colorectal cancer treatment has been slow owing to initial case study results suggesting high recurrence rates at port sites. The use of laparoscopic surgery for colorectal cancer still raises a number of concerns, particularly with the technique's complexity, learning curve and longer duration. After exploring the scientific literature comparing open and laparoscopic surgery for the treatment of colorectal cancer with respect to oncologic efficacy and shortterm outcomes, the Comité de l'évolution des pratiques en oncologie (CEPO) made recommendations for surgical practice in Quebec.Methods: Scientific literature published from January 1995 to April 2012 was reviewed. Phase III clinical trials and meta-analyses were included.Results: Sixteen randomized trials and 10 meta-analyses were retrieved. Analysis of the literature confirmed that for curative treatment of colorectal cancer, laparoscopy is not inferior to open surgery with respect to survival and recurrence rates. Moreover, laparoscopic surgery provides short-term advantages, including a shorter hospital stay, reduced analgesic use and faster recovery of intestinal function. However, this approach does require a longer operative time.

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“…The morbidity (LAC 40%, OC 37%, P = 0.424) and mortality (LAC 1%, OC 2%, P = 0.409) within 28 days of surgery were also similar. The conversion rate was 16%, equivalent to the most recent data 61) . Anastomotic leakage rates were similar between the two groups (LAC 13%, OC 10%, P = 0.462).…”

Section: Long -Term Outcomes (Table 4)mentioning

confidence: 99%

An evidence-based medicine approach to the laparoscopic treatment of colorectal cancer

Otani

Isohata

Kumamoto

et al. 2016

FJMS

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During the 1990s, laparoscopic resection was established as a treatment for gastrointestinal malignant tumors. A number of randomized controlled trials comparing laparoscopic -assisted colorectal surgery with conventional open colorectal surgery for colon cancer have been conducted. These trials have shown short -term benefits, and the vast majority demonstrated no significant difference in long -term outcomes. Laparoscopic -assisted colorectal surgery is widely performed for the treatment of colon cancer, whereas laparoscopic -assisted colorectal surgery for rectal cancer is less commonly performed. In recent years, there have been an increasing number of reports of laparoscopic -assisted colorectal surgery for rectal cancer, where improving short -term outcomes was shown, but no definitive effect on long -term survival has been shown to date. Randomized controlled trials focusing on long -term survival are currently ongoing.

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A Meta-analysis of the Short- and Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Conventional Open Surgery for Rectal Cancer

Abstract: Laparoscopic surgery may be an acceptable alternative treatment option to conventional open surgery for rectal cancer.

Cited by 93 publications

References 35 publications

Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials

Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials

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

An evidence-based medicine approach to the laparoscopic treatment of colorectal cancer

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