Meta-Analysis
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World J Gastroenterol. Apr 7, 2014; 20(13): 3680-3692
Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3680
Evidence based medicine and surgical approaches for colon cancer: Evidences, benefits and limitations of the laparoscopic vs open resection
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri, Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology University of Rome “La Sapienza”, 00189 Rome, Italy
Author contributions: Lorenzon L, La Torre M, Ziparo V and Ferri M designed the manuscript; Lorenzon L, Montebelli F and Mercantini P performed the database search; Montebelli F, Mercantini P and Balducci G assessed manuscripts for inclusion/exclusion; Lorenzon L, Ziparo V, Mercantini P and Balducci G performed the systematic review; Lorenzon L, La Torre M and Ferri M performed the meta-analysis; Lorenzon L, La Torre M and Ferri M wrote the paper; all authors have reviewed and approved the manuscript in its final form.
Supported by The PhD University Grant program “Clinical and Experimental Research Methodologies in Oncology” provided by the Faculty of Medicine and Psychology University of Rome “La Sapienza” to La Torre M
Correspondence to: Laura Lorenzon, MD, PhD, Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology University of Rome “La Sapienza”, Via di Grottarossa 1035-39, 00189 Rome, Italy. laura.lorenzon@uniroma1.it
Telephone: +39-633-775989 Fax: +39-633-775322
Received: September 29, 2013
Revised: December 26, 2013
Accepted: February 17, 2014
Published online: April 7, 2014
Processing time: 187 Days and 11 Hours
Abstract

AIM: To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection.

METHODS: Forty-seven manuscripts were reviewed, 33 of which employed for meta-analysis according to the PRISMA guidelines. The results were differentiated according to the study design (prospective randomized trials vs case-control series) and according to the tumor’s location. Outcome measures included: (1) short-term results (operating times, blood losses, bowel function recovery, post-operative pain, return to the oral intake, complications and hospital stay); (2) oncological adequateness (number of nodes harvested in the surgical specimens); and (3) long-term results (including the survivals’ rates and incidence of incisional hernias) and (4) costs.

RESULTS: Meta-analysis of trials provided evidences in support of the laparoscopic procedures for a several short-term outcomes including: a lower blood loss, an earlier recovery of the bowel function, an earlier return to the oral intake, a shorter hospital stay and a lower morbidity rate. Opposite the operating time has been confirmed shorter in open surgery. The same trend has been reported investigating case-control series and cancer by sites, even though there are some concerns regarding the power of the studies in this latter field due to the small number of trials and the small sample of patients enrolled. The two approaches were comparable regarding the mean number of nodes harvested and long-term results, even though these variables were documented reviewing the literature but were not computable for meta-analysis. The analysis of the costs documented lower costs for the open surgery, however just few studies investigated the incidence of post-operative hernias.

CONCLUSION: Laparoscopy is superior for the majority of short-term results. Future studies should better differentiate these approaches on the basis of tumors’ location and the post-operative hernias.

Keywords: Laparoscopy; Colon resection; Colon cancer; Meta-analysis; Evidence-based medicine

Core tip: This is a comprehensive meta-analysis of studies investigating laparoscopic resection in comparison with the open surgery for colon cancer, with the aim of evidencing short term and long term results of the surgical approaches. Results were provided according to the study designs (randomized trials, case control series) and according to the tumor’s location.