Laparoscopic versus open surgery for rectal cancer: Results of a systematic review and meta‑analysis on clinical efficacy

Zhao,Jun‑Kang; Chen,Nan‑Zheng; Zheng,Jian‑Bao; He,Sai; Sun,Xue‑Jun

doi:10.3892/mco.2014.345

Laparoscopic versus open surgery for rectal cancer: Results of a systematic review and meta‑analysis on clinical efficacy

Authors:
- Jun‑Kang Zhao
- Nan‑Zheng Chen
- Jian‑Bao Zheng
- Sai He
- Xue‑Jun Sun
View Affiliations

Affiliations: Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
Published online on: July 11, 2014 https://doi.org/10.3892/mco.2014.345
Pages: 1097-1102

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Colorectal cancer is one of the main malignant tumors threatening human health. Surgery plays a pivotal role in treating colorectal cancer. The present study aimed to compare the clinical effect in patients with rectal cancer undergoing laparoscopic versus open surgery by meta‑analysis of the randomized controlled trials (RCTs) published in the past 20 years. The data showed that 14 RCTs comparing laparoscopic surgery with conventional open surgery for rectal cancer matched the selection criteria and reported on 2,114 subjects, of whom 1,111 underwent laparoscopic surgery and 1,003 underwent open surgery for rectal cancer. Blood loss (P<0.00001), days to passage of flatus (P=0.0003), first bowel movement (P=0.0006), fluids intake (P<0.00001), walking independently (P<0.00001), length of hospital duration (P=0.003) and the rate of wound infection (P=0.04) were all significantly reduced following laparoscopic surgery. The incidence of complications, such as ureteric injury (P=0.33), urinary retention (P=0.43), ileus (P=0.05), anastomotic leakage (P=0.09) and incisional hernia (P=0.88), were not significantly different between the two groups. There were no significant differences in lymph nodes harvested (P=0.88), length of specimen (P=0.60), circumferential resection margin (CRM) (P=0.86), regional recurrence ((P=0.08), port site or wound metastasis (P=0.67), distant metastasis (P=0.12), 3‑year overall survival (OS) (P=0.42), 3‑year disease‑free survival (DFS) (P=0.44), 5‑year OS (P=0.60) and 5‑year DFS (P=0.70). Therefore, laparoscopy for the treatment of patients with rectal cancer has the advantage of recovery and the same complications and prognosis as laparotomy, which indicates that laparoscopy may provide a potential survival benefit for patients with rectal cancer.

View Figures

View References

1	Siegel R, Desantis C and Jemal A: Colorectal cancer statistics, 2014. CA Cancer J Clin. 64:104–117. 2014. View Article : Google Scholar
2	Buunen M, Veldkamp R, Hop WC, et al; Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 10:44–52. 2009. View Article : Google Scholar : PubMed/NCBI
3	Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM and Guillou PJ: Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 97:1638–1645. 2010.
4	Higgins JPT and Green S: Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011, Available from www.cochrane-handbook.orgurisimplewww.cochrane-handbook.org.
5	Hozo SP, Djulbegovic B and Hozo I: Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 5:132005. View Article : Google Scholar
6	Tierney JF, Stewart LA, Ghersi D, Burdett S and Sydes MR: Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 8:162007. View Article : Google Scholar : PubMed/NCBI
7	Jayne DG, Guillou PJ, Thorpe H, et al; UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 25:3061–3068. 2007.PubMed/NCBI
8	Guillou PJ, Quirke P, Thorpe H, et al; MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 365:1718–1726. 2005. View Article : Google Scholar
9	Araujo SE, da Silva eSousa AH Jr, de Campos FG, et al: Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial. Rev Hosp Clin Fac Med Sao Paulo. 58:133–140. 2003. View Article : Google Scholar
10	Zhou ZG, Hu M, Li Y, et al: Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc. 18:1211–1215. 2004. View Article : Google Scholar : PubMed/NCBI
11	Arteaga González I, Díaz Luis H, Martín Malagón A, López-Tomassetti Fernández EM, Arranz Duran J and Carrillo Pallares A: A comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curve. Int J Colorectal Dis. 21:590–595. 2006.PubMed/NCBI
12	Braga M, Frasson M, Vignali A, Zuliani W, Capretti G and Di Carlo V: Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum. 50:464–471. 2007. View Article : Google Scholar : PubMed/NCBI
13	Pechlivanides G, Gouvas N, Tsiaoussis J, et al: Lymph node clearance after total mesorectal excision for rectal cancer: laparoscopic versus open approach. Dig Dis. 25:94–99. 2007. View Article : Google Scholar : PubMed/NCBI
14	Pan YF, Zhang XH, Jia XJ, et al: Laparoscopic abdominoperineal resection for low rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 10:253–256. 2007.(In Chinese).
15	Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY and Leung WW: Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol. 15:2418–2425. 2008. View Article : Google Scholar : PubMed/NCBI
16	Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD and Parrilla P: Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg. 96:982–989. 2009. View Article : Google Scholar
17	Ng SS, Leung KL, Lee JF, et al: Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum. 52:558–566. 2009.PubMed/NCBI
18	Kang SB, Park JW, Jeong SY, et al: Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 11:637–645. 2010. View Article : Google Scholar
19	Liang X, Hou S, Liu H, et al: Effectiveness and safety of laparoscopic resection versus open surgery in patients with rectal cancer: a randomized, controlled trial from China. J Laparoendosc Adv Surg Tech A. 21:381–385. 2011. View Article : Google Scholar : PubMed/NCBI
20	Veenhof AA, Sietses C, von Blomberg BM, et al: The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer: a randomized trial. Int J Colorectal Dis. 26:53–59. 2011. View Article : Google Scholar
21	Hawk ET, Limburg PJ and Viner JL: Epidemiology and prevention of colorectal cancer. Surg Clin North Am. 82:905–941. 2002. View Article : Google Scholar : PubMed/NCBI
22	Lin JZ and Pan ZZ: Disputes about surgical treatment of colorectal liver metastasis. Zhonghua Wei Chang Wai Ke Za Zhi. 16:714–717. 2013.(In Chinese).
23	Chand M, Bhoday J, Brown G, Moran B and Parvaiz A: Laparoscopic surgery for rectal cancer. J R Soc Med. 105:429–435. 2012. View Article : Google Scholar : PubMed/NCBI
24	Luna-Pérez P, Bustos-Cholico E, Alvarado I, Maffuz A, Rodríguez-Ramírez S, Gutiérrez de la Barrera M and Labastida S: Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection. J Surg Oncol. 90:20–25. 2005.PubMed/NCBI
25	Adam IJ, Mohamdee MO, Martin IG, et al: Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 344:707–711. 1994. View Article : Google Scholar : PubMed/NCBI
26	Huang MJ, Liang JL, Wang H, Kang L, Deng YH and Wang JP: Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis. 26:415–421. 2011. View Article : Google Scholar : PubMed/NCBI
27	Ren KY: Comparison of short-term efficacy between laparoscopic and open resection of colorectal cancer. Chin J Gen Surg. 22:374–376. 2013.
28	Chen XX, Zhou YC, Zhang ZM, Wei ZX, Huang KW, Zhou WM and Long XF: Comparative study on laparoscopic and open resection for low rectal cancer. Chin J Gen Surg. 20:356–359. 2011.
29	Quah HM, Jayne DG, Eu KW and Seow-Choen F: Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg. 89:1551–1556. 2002. View Article : Google Scholar
30	Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P and Guillou PJ: Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg. 92:1124–1132. 2005. View Article : Google Scholar : PubMed/NCBI
31	Bujko K, Kepka L, Michalski W and Nowacki MP: Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol. 80:4–12. 2006. View Article : Google Scholar
32	Lundh A and Gøtzsche PC: Recommendations by Cochrane Review Groups for assessment of the risk of bias in studies. BMC Med Res Methodol. 8:222008. View Article : Google Scholar : PubMed/NCBI
33	Yao XQ, Ou-Yang ZA, Lin F, Qing SH, Huang XC and Zhang SZ: Affecting factors of prognosis for total mesorectal excision of rectal cancer. Chin J Clin Anatomy. 23:547–549. 2005.(In Chinese).