Laparoscopic <i>vs</i> open resection for rectal cancer: a meta‐analysis of randomized clinical trials

Trastulli, Stefano; Cirocchi, Roberto; Listorti, Chiara; Cavaliere, Davide; Avenia, Nicola; Gullà, N; Giustozzi, Giammario; Sciannameo, Francesco; Noya, Giuseppe; Boselli, Carlo

doi:10.1111/j.1463-1318.2012.02985.x

Cited by 148 publications

(111 citation statements)

References 61 publications

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“…Of the 16 RCTs, 15 reported adequate randomized sequence generation (Zhou et al, 2004;Guillou et al, 2005;Braga et al, 2007;Jayne et al, 2007;Pan et al, 2007; Pechlivanides et al, 2007;Ng et al, 2008;Lujan et al, 2009;Ng et al, 2009;Jayne et al, 2010;Kang et al, 2010;Liang et al, 2011;Zhang et al, 2012;Green et al, 2013;van der Pas et al, 2013), 10 reported allocation concealment (Guillou et al, 2005;Braga et al, 2007;Jayne et al, 2007;Ng et al, 2008;Lujan et al, 2009;Ng et al, 2009;Jayne et al, 2010;Kang et al, 2010;Green et al, 2013;van der Pas et al, 2013). Only 2 reported blinding of outcome assessment (Braga et al, 2007;Liang et al, 2011) and 3 RCTs (Jayne et al, 2007;Jayne et al, 2010;Green et al, 2013) which's outcomes were objective such as overall survival, local recurrence were not appropriate for evaluating this item.…”

Section: Quality Of Included Rctsmentioning

confidence: 99%

“…Only 2 reported blinding of outcome assessment (Braga et al, 2007;Liang et al, 2011) and 3 RCTs (Jayne et al, 2007;Jayne et al, 2010;Green et al, 2013) which's outcomes were objective such as overall survival, local recurrence were not appropriate for evaluating this item. Eleven did the intent-to-treat analysis (Guillou et al, 2005;Braga et al, 2007;Jayne et al, 2007;Ng et al, 2008;Lujan et al, 2009;Ng et al, 2009;Jayne et al, 2010;Kang et al, 2010;Liang et al, 2011;Green et al, 2013;van der Pas et al, 2013) and reported the patients lost to follow-up (Guillou et al, 2005;Braga et al, 2007;Jayne et al, 2007;Ng et al, 2008;Ng et al, 2009;Jayne et al, 2010;Kang et al, 2010;Liang et al, 2011;Zhang et al, 2012;Green et al, 2013;van der Pas et al, 2013) in detail.…”

Section: Quality Of Included Rctsmentioning

confidence: 99%

“…All studies matching in age, sex and pathological stage, 1804 (59%) underwent laparoscopic surgery and 1241 (41%) underwent open rectal cancer surgery, four (Guillou et al, 2005;Jayne et al, 2007;Jayne et al, 2010;Green et al, 2013) of them reported different outcomes come from the same multicentre trial of the UK MRC CLASICC trial, therefore, the sample size is calculated only once. The rest multicentre studies are these trials (Pechlivanides et al, 2007;Kang et al, 2010;van der Pas et al, 2013). The mean follow-up ranged from 3 to112.5 months.…”

Section: Studies Selectedmentioning

confidence: 99%

“…16 RCTs (Araujo et al, 2003;Zhou et al, 2004;Guillou et al, 2005;Braga et al, 2007;Jayne et al, 2007;Pan et al, 2007;Pechlivanides et al, 2007;Ng et al, 2008;Lujan et al, 2009;Ng et al, 2009;Kang et al, 2010;Liang et al, 2011;Zhang et al, 2012;Green et al, 2013;van der Pas et al, 2013) involving 3045 participants met the inclusion criteria were included in this meta-analysis, published year ranged from 2003 to 2013. All studies matching in age, sex and pathological stage, 1804 (59%) underwent laparoscopic surgery and 1241 (41%) underwent open rectal cancer surgery, four (Guillou et al, 2005;Jayne et al, 2007;Jayne et al, 2010;Green et al, 2013) of them reported different outcomes come from the same multicentre trial of the UK MRC CLASICC trial, therefore, the sample size is calculated only once.…”

Section: Studies Selectedmentioning

confidence: 99%

See 3 more Smart Citations

Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Zhang

Zhou²,

Wang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Section: Quality Of Included Rctsmentioning

confidence: 99%

Section: Quality Of Included Rctsmentioning

confidence: 99%

Section: Studies Selectedmentioning

confidence: 99%

Section: Studies Selectedmentioning

confidence: 99%

See 2 more Smart Citations

Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Zhang

Zhou²,

Wang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…In another study [6], while The United States Association of Colorectal Surgeons did not encourage laparoscopy, in other countries this procedure is found safe and comparable with open surgery regarding relapses and 3 years survival. Laparoscopy was found superior in high risk patients (in a study over 424 cases [7]) and also in reducing postoperative blood loss, low incidence of intestinal obstruction by adhesions and reduced long term morbidity compared with classic surgery in 1544 cases, without significant changes in local or distant relapses [8].…”

Section: Introductionmentioning

confidence: 99%

European Colorectal Cancer Management: Implemented as it is or Adapted to our National Specificity

Dobre

Hintea

Azamfirei

2015

Acta Medica Marisiensis

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Objective: We attempt to evaluate how the European treatment guides are implemented in a clinic hospital in Targu Mures and if those rules could be adopted as they are or must be adapted to our national specificity. Methods: For a number of 441 patients included in the study, the electronic prospectively maintained archive of 3rd Surgery was interrogated for: age, preoperative colonoscopy, postoperative colonoscopies, chemo-radiotherapy enrollment, stage of the disease, type of surgery. Local and regional relapses were assessed and their incidence was related to type of surgery. Survival analysis was done in a simplified manner and differentiated for age below and above 75 years. Results: Patient's age distribution revealed a deviation to the right compared with a normal distribution with a median off 64.76±11.47. Colonoscopy was done in only 65 cases, exclusive preoperatively. Chemoradiotherapy was administered in 168 cases, only 12 of them initiated preoperatively. The type of surgery performed was found positively correlate with the stage of the disease. The survival probability for the patients in this study showed a 50% survival rate at 1 year and only 2% at 5 years. Conclusions: Passive screening age in CRC should be decreased to 55 years. Stage 3 and 4 of disease for CRC are over 70% of cases, like 20 years ago. Survival rate in CRC is far lower than other studies. Integrated CRC management and European practical guides are still "in wishing" stage.

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Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes

Fleshman

Branda

Sargent

et al. 2015

JAMA

1,021

744

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IMPORTANCE Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease. OBJECTIVE To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen. DESIGN, SETTING, AND PARTICIPANTS A multicenter, balanced, noninferiority, randomized trial enrolled patients between October 2008 and September 2013. The trial was conducted by credentialed surgeons from 35 institutions in the United States and Canada. A total of 486 patients with clinical stage II or III rectal cancer within 12 cm of the anal verge were randomized after completion of neoadjuvant therapy to laparoscopic or open resection. INTERVENTIONS Standard laparoscopic and open approaches were performed by the credentialed surgeons. MAIN OUTCOMES AND MEASURES The primary outcome assessing efficacy was a composite of circumferential radial margin greater than 1 mm, distal margin without tumor, and completeness of total mesorectal excision. A 6%noninferiority margin was chosen according to clinical relevance estimation. RESULTS Two hundred forty patients with laparoscopic resection and 222 with open resection were evaluable for analysis of the 486 enrolled. Successful resection occurred in 81.7%of laparoscopic resection cases (95%CI, 76.8%–86.6%) and 86.9%of open resection cases (95%CI, 82.5%–91.4%) and did not support noninferiority (difference, −5.3%; 1-sided 95%CI, −10.8%to ∞; P for noninferiority = .41). Patients underwent low anterior resection (76.7%) or abdominoperineal resection (23.3%). Conversion to open resection occurred in 11.3%of patients. Operative time was significantly longer for laparoscopic resection (mean, 266.2 vs 220.6 minutes; mean difference, 45.5 minutes; 95%CI, 27.7–63.4; P < .001). Length of stay (7.3 vs 7.0 days; mean difference, 0.3 days; 95%CI, −0.6 to 1.1), readmission within 30 days (3.3%vs 4.1%; difference, −0.7%; 95%CI, −4.2%to 2.7%), and severe complications (22.5%vs 22.1%; difference, 0.4%; 95%CI, −4.2%to 2.7%) did not differ significantly. Quality of the total mesorectal excision specimen in 462 operated and analyzed surgeries was complete (77%) and nearly complete (16.5%) in 93.5%of the cases. Negative circumferential radial margin was observed in 90% of the overall group (87.9% laparoscopic resection and 92.3%open resection; P = .11). Distal margin result was negative in more than 98%of patients irrespective of type of surgery (P = .91). CONCLUSIONS AND RELEVANCE Among patients with stage II or III rectal cancer, the use of laparoscopic resection compared with open resection failed to meet the criterion for noninferiority for pathologic outcomes. Pending clinical oncologic outcomes, the findings do not support the use of laparoscopic resection in these patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00726622

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Laparoscopic vs open resection for rectal cancer: a meta‐analysis of randomized clinical trials

Cited by 148 publications

References 61 publications

Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

European Colorectal Cancer Management: Implemented as it is or Adapted to our National Specificity

Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes

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