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
Processing time: 139 Days and 6.6 Hours
Abstract
AIM

To review evidence on the short-term clinical outcomes of laparoscopic (LRR) vs open rectal resection (ORR) for rectal cancer.

METHODS

A systematic literature search was performed using Cochrane Central Register, MEDLINE, EMBASE, Scopus, OpenGrey and ClinicalTrials.gov register for randomized clinical trials (RCTs) comparing LRR vs ORR for rectal cancer and reporting short-term clinical outcomes. Articles published in English from January 1, 1995 to June, 30 2016 that met the selection criteria were retrieved and reviewed. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statements checklist for reporting a systematic review was followed. Random-effect models were used to estimate mean differences and risk ratios. The robustness and heterogeneity of the results were explored by performing sensitivity analyses. The pooled effect was considered significant when P < 0.05.

RESULTS

Overall, 14 RCTs were included. No differences were found in postoperative mortality (P = 0.19) and morbidity (P = 0.75) rates. The mean operative time was 36.67 min longer (95%CI: 27.22-46.11, P < 0.00001), the mean estimated blood loss was 88.80 ml lower (95%CI: -117.25 to -60.34, P < 0.00001), and the mean incision length was 11.17 cm smaller (95%CI: -13.88 to -8.47, P < 0.00001) for LRR than ORR. These results were confirmed by sensitivity analyses that focused on the four major RCTs. The mean length of hospital stay was 1.71 d shorter (95%CI: -2.84 to -0.58, P < 0.003) for LRR than ORR. Similarly, bowel recovery (i.e., day of the first bowel movement) was 0.68 d shorter (95%CI: -1.00 to -0.36, P < 0.00001) for LRR. The sensitivity analysis did not confirm a significant difference between LRR and ORR for these latter two parameters. The overall quality of the evidence was rated as high.

CONCLUSION

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.

Keywords: Laparoscopic rectal resection; Open rectal resection; Laparoscopy; Rectal cancer; Postoperative morbidity; Short-term outcomes; Systematic review; Meta-analysis

Core tip: There is no consensus on which technique, between laparoscopic rectal resection (LRR) and open rectal resection (ORR), is more beneficial for the patient. A systematic review and meta-analysis exclusively based on randomized clinical trials comparing LRR vs ORR has been performed. The pooled analyses focused on the evaluation and comparison of short-term clinical outcomes and showed that postoperative morbidity and mortality are similar between the two surgical approaches. However, LRR is associated with lesser blood loss and smaller incision length, which may represent clinical advantages for the patient.