Oncological outcomes of laparoscopic versus open rectal cancer resections: meta-analysis of randomized clinical trials

Abstract

Background The role of laparoscopic rectal cancer surgery has been questioned owing to conflicting reports on pathological outcomes from recent RCTs. However, it is unclear whether these pathological markers and the surgical approach have an impact on oncological outcomes. This study assessed oncological outcomes of laparoscopic and open rectal cancer resections. Methods A meta-analysis of RCTs was performed. Primary endpoints included oncological outcomes (disease-free survival (DFS), overall survival (OS), local recurrence). Secondary endpoints included surrogate markers for the quality of surgical resection. Results Twelve RCTs including 3744 patients (2133 laparoscopic, 1611 open) were included. There was no significant difference in OS (hazard ratio (HR) 0.87, 95 per cent c.i. 0.73 to 1.04; P = 0.12; I2 = 0 per cent) and DFS (HR 0.95, 0.81 to 1.11; P = 0.52; I2 = 0 per cent) between laparoscopic and open rectal resections. There was no significant difference in locoregional (odds ratio (OR) 1.03, 95 per cent c.i. 0.72 to 1.48; P = 0.86; I2 = 0 per cent) or distant (OR 0.87, 0.70 to 1.08; P = 0.20; I2 = 7 per cent) recurrence between the groups. Achieving a successful composite score (intact mesorectal excision, clear circumferential resection margin and distal margin) was significantly associated with improved DFS (OR 0.55, 0.33 to 0.74; P < 0.001; I2 = 0 per cent). An intact or acceptable mesorectal excision (intact mesorectal excision with or without superficial defects) had no impact on DFS. Finally, a positive CRM was associated with worse DFS. Conclusion Well performed surgery (laparoscopic or open) achieves excellent oncological outcomes with very little difference between the two modalities. The advantage and benefit of minimally invasive surgery should be assessed on an individual basis.

Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life

“…Nowadays, the treatment of rectal cancer is adopting a more multimodal approach, but surgical resection is still the cornerstone of curative treatment [4]. Over the past decades, the 5-year survival has gone up to 75-80% [5]. The increased survival over the past decades and enlarged focus on valuebased healthcare account for the growing interest in the quality of life after cancer treatment [6][7][8].…”

Verbreitung von Fast-Track-Konzepten in Deutschland

“…Die Vorteile der Laparoskopie sind seit vielen Jahren bekannt. Eine schnellere Rekonvaleszenz bei vergleichbaren onkologischen Ergebnissen sind durch eine Vielzahl an Studien belegt [ 14 – 16 ]. Bei den Rektumresektionen ist der Anteil laparoskopischer Eingriffe in den letzten 6 Jahren relevant angestiegen von 32,80 % im Jahr 2016 auf 49,34 % im Jahr 2021.…”

Comparison of Non-Oncological Postoperative Outcomes Following Robotic and Laparoscopic Colorectal Resection for Colorectal Malignancy: A Systematic Review and Meta-Analysis

“…This was further augmented by the introduction of the robotic system, da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA). Various studies and metaanalyses have compared laparoscopic with open colectomies to establish similar safety and oncological outcomes [3,4]. Laparoscopic surgery has several disadvantages including its learning curve, its fulcrum effect, and a limited degree of freedom.…”