BACKGROUND: Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer. METHODS: A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the I (2) test and subgroup analysis on surgical and medical complications. RESULTS: Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21-0.99, p = 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76-0.91, p < 0.001). CONCLUSIONS: On the basis of evidence of both randomized and prospective controlled series, mortality and morbidity RR, including subgroup analysis, were significantly lower after laparoscopic compared to open surgery.
BACKGROUND: Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer. METHODS: A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the I (2) test and subgroup analysis on surgical and medical complications. RESULTS: Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21-0.99, p = 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76-0.91, p < 0.001). CONCLUSIONS: On the basis of evidence of both randomized and prospective controlled series, mortality and morbidity RR, including subgroup analysis, were significantly lower after laparoscopic compared to open surgery.
Authors: Ruben Veldkamp; Esther Kuhry; Wim C J Hop; J Jeekel; G Kazemier; H Jaap Bonjer; Eva Haglind; Lars Påhlman; Miguel A Cuesta; Simon Msika; Mario Morino; Antonio M Lacy Journal: Lancet Oncol Date: 2005-07 Impact factor: 41.316
Authors: Seung Hyuk Baik; Mikhail Gincherman; Matthew G Mutch; Elisa H Birnbaum; James W Fleshman Journal: Dis Colon Rectum Date: 2011-01 Impact factor: 4.585
Authors: Heidi Nelson; Daniel J Sargent; H Sam Wieand; James Fleshman; Mehran Anvari; Steven J Stryker; Robert W Beart; Michael Hellinger; Richard Flanagan; Walter Peters; David Ota Journal: N Engl J Med Date: 2004-05-13 Impact factor: 91.245
Authors: Simon S M Ng; Ka Lau Leung; Janet F Y Lee; Raymond Y C Yiu; Jimmy C M Li; Anthony Y B Teoh; Wing Wa Leung Journal: Ann Surg Oncol Date: 2008-04-05 Impact factor: 5.344