Laparoscopic Versus Open Surgery for Mid-Low Rectal Cancer: a Systematic Review and Meta-Analysis on Short- and Long-Term Outcomes

Jiang, Jianjun; Jiang, Kun; Dai, Yong; Wang, Ru-xia; Wu, Wei; Wang, Jingjing; Xie, Fei; Li, Xuemei

doi:10.1007/s11605-015-2857-5

Cited by 38 publications

(27 citation statements)

References 63 publications

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“…In a comparison of the long-term outcomes after laparoscopic TME and open TME, similar local recurrence, distant metastasis, and tumor-free survival rates were found. 15 Considering the early period oncologic results of robotic TMEs in rectal cancers, both the laparoscopic and open TME are similar in this regard. 18 However, some researchers have reported that robotic surgery provides better outcomes.…”

Section: Discussionmentioning

confidence: 96%

“… 13 , 14 As such, laparoscopic TME is performed increasingly, because its benefits are not less than those of open surgery, especially in long-term oncologic outcomes. 15 Nevertheless, despite all the aforementioned advantages, laparoscopic TME is a difficult procedure, even for experienced surgeons. For this reason, laparoscopic TME is still the less frequently preferred option worldwide, as opposed to an open TME for rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

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Robotic Versus Laparoscopic Resection for Mid and Low Rectal Cancers

Bedirli

Salman

Yüksel

2016

JSLS

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Background and Objectives:The current study was conducted to determine whether robotic low anterior resection (RLAR) has real benefit over laparoscopic low anterior resection (LLAR) in terms of surgical and early oncologic outcomes.Methods:We retrospectively analyzed data from 35 RLARs and 28 LLARs, performed for mid and low rectal cancers, from January 2013 through June 2015.Results:A total of 63 patients were included in the study. All surgeries were performed successfully. The clinicopathologic characteristics were similar between the 2 groups. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss (165 vs. 120 mL; P < .05) and higher mean operative time (252 vs. 208 min; P < .05). No significant differences were observed in the time to flatus passage, length of hospital stay, and postoperative morbidity. Pathological examination of total mesorectal excision (TME) specimens showed that both circumferential resection margin and transverse (proximal and distal) margins were negative in the RLAR group. However, 1 patient each had positive circumferential resection margin and positive distal transverse margin in the LLAR group. The mean number of harvested lymph nodes was 27 in the RLAR group and 23 in the LLAR group.Conclusions:In our study, short-term outcomes of robotic surgery for mid and low rectal cancers were similar to those of laparoscopic surgery. The quality of TME specimens was better in the patients who underwent robotic surgery. However, the longer operative time was a limitation of robotic surgery.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Robotic Versus Laparoscopic Resection for Mid and Low Rectal Cancers

Bedirli

Salman

Yüksel

2016

JSLS

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“…Two recent meta-analysis for long-term survival focused on relative risks showed a similar result for overall survival and disease-free survival (RR = 1.06, 95 % CI 0.96–1.18, I 2 = 14 %; RR = 1.04, 95 % CI 0.95–1.14, I 2 = 0 %) in 4 studies with 847 patients [ 23 ]. Though there are some other meta-analysis focus on this topic [ 24 , 25 ], odds ratios and continuous variables were presented in the form of weighted mean differences with 95 % credible intervals. In systematic reviews and meta-analysis, time-to-event outcomes are most appropriately analyzed using hazard ratios.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open surgery for rectal cancer: a meta-analysis of 3-year follow-up outcomes

Zhao

Wang

et al. 2016

Int J Colorectal Dis

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purposeWe wished to evaluate the effectiveness of laparoscopic and open surgery for patients with rectum cancer through a meta-analysis.MethodsWe searched PubMed, EMBASE, and Cochrane database until June 30, 2015, to identify eligible studies. Randomized controlled trials comparing laparoscopic with open surgery for rectum cancer were included. Meta-analysis was performed using the search strategy following the requirement of the Cochrane Library Handbook. Three-year overall survival (OS) and disease-free survival (DFS) were the main endpoints.ResultsEight randomized controlled trials comprising 3145 patients matched the selection criteria. Meta-analysis showed no significant difference between laparoscopic and open surgery in 3-year overall survival (OS) and disease-free survival (DFS) (hazard ratio (HR)3-year OS = 0.83, 95 % CI [0.68–1.01]; P = 0.06; HR3-year DFS = 0.89, 95 % CI [0.75,1.05]; P = 0.16). No evidence of publication bias was observed.ConclusionOur meta-analysis supported the notion that based on the 3-year DFS and OS, oncological outcomes are comparable after laparoscopic and open surgery for rectal cancer.

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“…To date, routine use of laparoscopic over open LAR for rectal cancer is not established in international guidelines. Despite high‐quality surgery, large robust randomized trials and meta‐analyses did not show non‐inferior oncologic outcomes for laparoscopic LAR . It is our opinion that the LA approach may bridge this gap between TL and open surgery in managing the entire range of rectal cancer presentations, without compromising on oncological outcomes.…”

Section: Discussionmentioning

confidence: 92%

Totally‐laparoscopic versus laparoscopic‐assisted low anterior resection for rectal cancer: are outcomes different?

Lai

et al. 2018

ANZ Journal of Surgery

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Laparoscopic Versus Open Surgery for Mid-Low Rectal Cancer: a Systematic Review and Meta-Analysis on Short- and Long-Term Outcomes

Abstract: This study suggests that the safety and feasibility of laparoscopic surgery appear to be equivalent to open surgery for treatment of mid- low rectal cancer, with the more favourable short-term benefits, fewer complications, comparable pathological outcomes and long-term outcomes.

Cited by 38 publications

References 63 publications

Robotic Versus Laparoscopic Resection for Mid and Low Rectal Cancers

Robotic Versus Laparoscopic Resection for Mid and Low Rectal Cancers

Laparoscopic versus open surgery for rectal cancer: a meta-analysis of 3-year follow-up outcomes

Totally‐laparoscopic versus laparoscopic‐assisted low anterior resection for rectal cancer: are outcomes different?

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