Role of laparoscopy in rectal cancer: A review

Table 1 Phase III randomized controlled trials showing oncological outcomes

Study and design	Recurrencelap vs open		Survivallap vs open		Tumorlocation(cm from AV)	Patient enrollment (n)		LN harvested(n)lap vs open	CRM positivitylap vs open
	DR	LR	DFS	OS		Open	Lap
Liang et al[17] Single center	N/A	N/A	N/A	76% vs 82.8% P = 0.46, (44 mo)	N/A	174	169	7.1 vs 7.4 P = 0.47	N/A
Kang et al[18] "COREAN" Multicenter	N/A	N/A	N/A	N/A	Lap-5.6 Open-5.3	170	170	17 vs 18 P = 0.08	5% vs 7% P = 0.77
Jayne et al[19] "CLASSIC" update Multicenter	21.9% vs 21.9% P = 0.86, (5 yr)	9.4% vs 7.6% P = 0.74, (5 yr)	53.2% vs 52.1% P = 0.95, (5 yr)	60.3% vs 52.9% P = 0.13, (5 yr)	N/A	128	253	N/A	N/A
Lujan et al[20] Single center	N/A	4.8% vs 5.3% P = 0.78, (5 yr)	84.8% vs 81% P = 0.9, (5 yr)	72.1% vs 75.3% P = 0.98, (5 yr)	Lap-5.5 Open-6.2	103	101	13.6 vs 11.6 P = 0.02	4% vs 3% P = 0.4
Ng et al[21] Single center	12.3% vs 18.1% P = 0.37, (10 yr)	7.1% vs 4.9% P = 0.68, (10 yr)	82.9% vs 80.4% P = 0.69, (10 yr)	83.5% vs 78% P = 0.59, (10 yr)	12-15	77	76	11.5 vs 12 P = 0.7	2.6% vs 1.3% P = 0.62
Ng et al[22] Single center	15% vs 25% P = 0.6, (5 yr)	5% vs 11% = 0.6, (5 yr)	78.1% vs 73.6% P = 0.55, (5 yr)	75.2% vs 76.5% P = 0.2, (5 yr)	≤ 5	48	51	12.4 vs 13 P = 0.72	5.8% vs 4.1% P = NS
Pechlivanides et al[23] Multicenter	N/A	N/A	N/A	N/A	Lap-6 Open-8	39	34	19.2 vs 19.2 P = 0.2	N/A
Braga et al[24] Single center	N/A	4% vs 5.3% P = 0.97 (5 yr)	N/A	No difference (5 yr)	Lap-9.1 Open-8.6	85	83	12.7 vs 13.6 P = NA	1.3% vs 2.4% P = NA

AV: Anal verge; N/A: Not applicable; OS: Overall survival; DFS: Disease free survival; LR: Local recurrence; DR: Distant recurrence; LN: Lymph nodes; CRM: Circumferential margins; NS: Non-significant; NA: Not available.

Table 2 Meta-analyses showing oncological outcomes

Ref.	Trials(n)	Patients(n)	OSlap vs open	DFSlap vs open	LRlap vs open	LN harvestedlap vs open (n)	CRM positivitylap vs open
Huang et al[25]	6	1033	HR = 0.76, P = 0.11, 4 trials (3 yr)	HR = 1.13, P = 0.64, 3 trials (3 yr)	RR = 0.55, P = 0.21, 4 trials (3 yr)	P = 0.43, 5 trials	7.94% vs 5.37%, P = 0.63, 5 trials (3 yr)
Ohtani et al[26]	12	2095	N/A	OR = 1.17, P = 0.35 (5 yr)	OR = 0.93, P = 0.61 (5 yr)	P = NS	P = NS
Anderson et al[27]	24	3158	72% vs 65%, P = NS, 13 trials (3 yr)	N/A	7% vs 8%, P = NS, 16 trials (3 yr)	10 vs 11, P = 0.001 17 trials	5% vs 8%, P = NS, 10 trials (3 yr)
Aziz et al[28]	20	2071	N/A	N/A	N/A	P = NS	9.5% vs 10.8%, OR = 0.93, P = 0.38

OS: Overall survival; DFS: Disease free survival; LR: Local recurrence; LN: Lymph nodes; CRM: Circumferential margins; HR: Hazard ratio; N/A: Not applicable; NS: Non-significant; OR: Odds ratio.

Table 3 Operative time for laparoscopic and open rectal resection data presented as mean ± SD, min

Ref.	Laparoscopy	Open	P value
Liang et al[17]	138 ± 24	119 ± 22	< 0.001
Kang et al[18]	245 ± 75	197 ± 63	< 0.001
Lujan et al[20]	194 ± 45	173 ± 59	0.02
Ng et al[21]	213 ± 59	154 ± 70	< 0.001
Ng et al[22]	214 ± 46	164 ± 43	< 0.001
Braga et al[24]	262 ± 72	209 ± 70	< 0.001
Zhou et al[30]	120	106	0.05

SD: Standard deviation.

Table 4 Estimated intraoperative blood loss and transfusion rate for laparoscopic and open rectal cancer resection

Ref.	EBL (mL)			Blood transfusion rate
	Lap	Open	P value	Lap	Open	P value
Liang et al[17]	N/A	N/A	N/A	2.4%	4.6%	0.38
Kang et al[18]	200	217.5	0.006	0%	0.005%	P > 0.99
Lujan et al[20]	127.8	234.2	P < 0.001	N/A	N/A	N/A
Ng et al[22]	321.7	555.6	P = 0.09	N/A	N/A	N/A
Braga et al[24]	150	350	P < 0.001	7.2%	26.8%	P = 0.002
Zhou et al[30]	20	92	P = 0.05	N/A	N/A	N/A

EBL: Estimated blood loss; N/A: Not applicable.

Table 5 Length of hospital stay

Ref.	Design	Measure	LOS
			Lap	Open	P value
Guillou et al[8] "CLASSIC"	RCT	Median (range)	13 (9-18)	11 (9-15)	N/A
Kang et al[18] "COREAN"	RCT	Median (range)	8 (7-12)	9 (8-12)	0.06
Lujan et al[20]	RCT	mean ± SD	8.2 ± 7.3	9.9 ± 6.8	0.11
Ng et al[21]	RCT	Median (range)	10.8 (5-27)	11.5 (3-38)	0.55
Ng et al[22]	RCT	Median (range)	8.4 (2-32)	10 (3-39)	0.013
Braga et al[24]	RCT	mean ± SD	10 ± 4.9	13 ± 10	0.004
Zhou et al[30]	RCT	mean ± SD	8.1 ± 3.1	13.3 ± 3.4	0.001
Aziz et al[28]	MA	MD (d)	-2.67 d, 95%CI: -3.8-(-1.54)		0.06
Arezzo et al[31]	MA	MD (d)	-2.7 d, 95%CI: -3.6-(-1.7)		0.001

RCT: Randomized controlled trial; MA: Meta-analysis; LOS: Length of stay; SD: Standard deviation; MD: Mean difference; CI: Confidence intervall; N/A: Not applicable.

Table 6 Bowel function recovery

Ref.	Design	Measurement	Lap	Open	P value
Time to peristalsis
Liang et al[17]	RCT	d	3.9	4.2	0.001
Ng et al[21]	RCT	d	4.1	4.7	0.06
Ng et al[22]	RCT	d	4.3	6.3	0.001
Guillou et al[8]	RCT	d	5	6	N/A
Zhou et al[30]	RCT	d	1.5	2.7	0.009
Aziz et al[28]	MA	d	MD -1.52 d [95%CI: -2.2-(-1.01), P = significant]
Time to 1st flatus
Ng et al[22]	RCT	d	3.1	4.6	0.001
Kang et al[18]	RCT	h	38.5	60	0.001
Time to 1st stool
Kang et al[18]	RCT	h	96.5	123	0.001
Liang et al[17]	RCT	d	3	3.3	0.001
Arezzo et al[31]	MA	d	3.3 vs 4.4
			MD -0.96 d [95% CI -1.3-(-0.6), P < 0.001]
Time to oral feeding initiation
Kang et al[18]	RCT	h	85	93	0.001
Guillou et al[8]	RCT	d	6	6	N/A
Ng et al[21]	RCT	d	4.3	4.9	0.001
Ng et al[22]	RCT	d	4.3	6.3	0.001
Aziz et al[28]	MA	d	MD -0.92 d [95%CI: -1.35-(-0.5), P = significant]
Arezzo et al[31]	MA	d	3.8 vs 4.8
			MD -1 d [95%CI: -1.4-(-0.7), P < 0.001]

RCT: Randomized controlled trial; MA: Meta-analysis; MD: Mean difference; N/A: Not applicable; CI: Confidence interval.