Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2017; 23(44): 7906-7916
Published online Nov 28, 2017. doi: 10.3748/wjg.v23.i44.7906
Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: A systematic review and meta-analysis
Aleix Martínez-Pérez, Maria Clotilde Carra, Francesco Brunetti, Nicola de’Angelis
Aleix Martínez-Pérez, Francesco Brunetti, Nicola de’Angelis, Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, 94010 Créteil, France
Aleix Martínez-Pérez, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, 46017 Valencia, Spain
Maria Clotilde Carra, Rothschild Hospital, AP-HP, Université Paris VII, 75012 Paris, France
Author contributions: Martínez-Pérez A and de’Angelis N contributed to conception and design of the study, and drafted the manuscript; Martínez-Pérez A, Carra MC and de’Angelis N contributed to data acquisition, data analysis and interpretation; Brunetti F critically revised the article; all authors approved the final version.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicola de’Angelis, MD, PhD, Assistant Professor, Department of Digestive, Hepato-biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. nicola.deangelis@aphp.fr
Telephone: +33-1-49812348 Fax: +33-1-49812432
Received: July 10, 2017
Peer-review started: July 12, 2017
First decision: August 30, 2017
Revised: September 9, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: November 28, 2017
ARTICLE HIGHLIGHTS
Research background

Laparoscopy is widely used for the resection of rectal cancer. The associated short-term benefits for the patient (e.g., fewer postoperative morbidity) have been highlighted in several studies, but with contrasting results. We conducted a systematic review and meta-analysis by selecting only randomized clinical trials (RCTs) that evaluated the short-term clinical outcomes of laparoscopic rectal resection (LRR) vs open rectal resection, (ORR) in patients with rectal cancer.

Research motivation

The short-term advantages of laparoscopic rectal resection remain under debate due to controversial results, especially when analyzing the most recent RCTs. Pooled data analyses of the available literature represents the best way to summarize the current evidence and support the development and widespread of the most advantageous surgical approach.

Research objectives

The main objective of the present systematic review and meta-analysis was to analyze the current literature of RCTs on the surgical treatment for rectal cancer to compare the short-term outcomes of laparoscopy vs open surgery. The analysis of the literature has also highlighted the level of evidence and risk of bias inherent in the available studies, which should be used to design future research on the treatment of rectal cancer.

Research methods

This is a systematic literature review and meta-analysis that was conducted by following the guidelines of the Cochrane Collaboration as well as the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statements checklist. Literature search was performed on different databases for articles published in English from January 1, 1995 to June, 30 2016. Random-effect models were used to estimate mean differences and risk ratios between LRR and ORR. The robustness and heterogeneity of the results were explored by performing sensitivity analyses.

Research results

Overall, 14 RCTs were analyzed. The mean operative time was longer for LRR than ORR, whereas the mean estimated blood loss and the mean incision length were lower for LRR than ORR. No differences between the two surgical approaches were found in postoperative mortality, morbidity, length of hospital stay, and time to bowel recovery. Although the overall quality of evidence was judged as high, not all the studies evaluated the same parameters. Thus, future research should use standardized definitions of postoperative outcomes in order to increase comparability and decrease heterogeneity among studies.

Research conclusions

LRR is associated with lesser blood loss, smaller incision length, and longer operative times compared to ORR. No differences are observed for postoperative morbidity and mortality. The short-term advantages of laparoscopic rectal resection are mainly represented by a significantly lower intraoperative blood loss and better cosmetic results compared to open surgery.

The overall level of evidence supporting these findings is high.

Research perspectives

Further studies should evaluate alternative minimally-invasive surgical techniques (e.g., transanal TME or Robotics) and compare them with laparoscopic and open approaches.