Meta-Analysis
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2014; 6(5): 209-219
Published online May 16, 2014. doi: 10.4253/wjge.v6.i5.209
Systematic review of oncological outcomes following laparoscopic vs open total mesorectal excision
Muhammad Shafique Sajid, Adil Ahamd, William FA Miles, Mirza Khurrum Baig
Muhammad Shafique Sajid, Adil Ahamd, William FA Miles, Mirza Khurrum Baig, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH United Kingdom
Author contributions: All authors contributed substantially in literature search, data extraction, trial selection, statistical analysis, and final drafting of this article; Sajid MS contributed to idea conception, data analysis, data interpretation, draft writing; Ahmad A contributed to draft writing; Miles WFA contributed to data confirmation, data interpretation, draft writing and supervising the study.
Correspondence to: Muhammad Shafique Sajid, Surgical Specialist Registrar, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Washington Suite, North Wing, West Sussex, BN11 2DH, United Kingdom. surgeon1wrh@hotmail.com
Telephone: +44-1903-205111 Fax: +44-1903-285010
Received: November 29, 2013
Revised: February 27, 2014
Accepted: March 11, 2014
Published online: May 16, 2014
Processing time: 171 Days and 17.4 Hours
Abstract

AIM: To systematically analyze the randomized trials comparing the oncological and clinical effectiveness of laparoscopic total mesorectal excision (LTME) vs open total mesorectal excision (OTME) in the management of rectal cancer.

METHODS: Published randomized, controlled trials comparing the oncological and clinical effectiveness of LTME vs OTME in the management of rectal cancer were retrieved from the standard electronic medical databases. The data of included randomized, controlled trials was extracted and then analyzed according to the principles of meta-analysis using RevMan® statistical software. The combined outcome of the binary variables was expressed as odds ratio (OR) and the combined outcome of the continuous variables was presented in the form of standardized mean difference (SMD).

RESULTS: Data from eleven randomized, controlled trials on 2143 patients were retrieved from the electronic databases. There was a trend towards the higher risk of surgical site infection (OR = 0.66; 95%CI: 0.44-1.00; z = 1.94; P < 0.05), higher risk of incomplete total mesorectal resection (OR = 0.62; 95%CI: 0.43-0.91; z = 2.49; P < 0.01) and prolonged length of hospital stay (SMD, -1.59; 95%CI: -0.86--0.25; z = 4.22; P < 0.00001) following OTME. However, the oncological outcomes like number of harvested lymph nodes, tumour recurrence and risk of positive resection margins were statistically similar in both groups. In addition, the clinical outcomes such as operative complications, anastomotic leak and all-cause mortality were comparable between both approaches of mesorectal excision.

CONCLUSION: LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary rectal cancer in both short term and long term follow ups.

Keywords: Total mesorectal excision; Anterior resection; Abdominoperineal resection; Rectal cancer; Oncological outcomes

Core tip: Based upon the findings of this systematic review of eleven randomized trial on 2143 patients of rectal cancer, there is a higher risk of surgical site infection, higher risk of incomplete total mesorectal resection and prolonged length of hospital stay following open total mesorectal excision (OTME) compared to laparoscopic total mesorectal excision (LTME). The number of harvested lymph nodes, tumour recurrence and risk of positive resection margins were statistically similar in both groups. In addition, the operative complications, anastomotic leak and mortality were comparable between LTME and OTME. LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary resectable rectal cancer.