Laparoscopic versus open surgery for rectal cancer: a meta-analysis

Omer Aziz, Vasilis Constantinides, Paris P Tekkis, Thanos Athanasiou, Sanjay Purkayastha, Paraskevas Paraskeva, Ara W Darzi, Alexander G Heriot
Annals of Surgical Oncology 2006, 13 (3): 413-24

BACKGROUND: Laparoscopic rectal cancer surgery aims to provide patients with curative resection while minimizing postoperative morbidity and mortality. This study used meta-analytical techniques to compare laparoscopic and open surgery as the primary treatment for patients with rectal cancer with regard to short-term and long-term outcomes.

METHODS: A literature search was performed on all studies between 1993 and 2004 comparing laparoscopic and open surgery for rectal cancer. Subgroup analysis was performed on patients undergoing abdominoperineal excision of the rectum. The following end points were evaluated: operative outcomes, postoperative recovery, and early and late adverse events.

RESULTS: Twenty studies matched the selection criteria and reported on 2071 subjects, of whom 909 (44%) underwent laparoscopic and 1162 (56%) underwent open surgery for rectal cancer. Time to stomal function (weighted mean difference [WMD], -1.52; 95% confidence interval [95% CI], -2.20, -1.01), first bowel movement (WMD, -.72; 95% CI, -1.21, -.22), feeding solids (WMD, -.92; 95% CI, -1.35, -.50), and length of hospital stay (WMD, -2.67; 95% CI, -3.81, -1.54) were all significantly reduced after laparoscopic surgery. In patients who underwent abdominoperineal excision of the rectum, wound infection (odds ratio, .15; 95% CI, .03, .73) and requirement for postoperative parenteral analgesia (WMD, -.63; 95% CI, -1.22, -.04) were also significantly reduced. There was no difference between groups in the extent of oncological clearance.

CONCLUSIONS: Laparoscopic rectal cancer surgery results in an earlier postoperative recovery and a resected specimen that is oncologically comparable to open surgery. Results from randomized trials reporting long-term outcomes such as cancer recurrence (local and metastatic) and 5-year survival are eagerly awaited.

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