Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled TrialsMing-Yang Shen, Ke-Yu Yang and Yong Zhou*
Department of the Fourth General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, PR China
- *Corresponding Author:
- Yong Zhou, Professor
Chief Physician, Department of the Fourth General Surgery
The Fourth Affiliated Hospital of China Medical University
Shenyang 110032, Liaoning Province, PR China
E-mail: [email protected]
Received Date: May 22, 2017; Accepted Date: June 20, 2017; Published Date: June 27, 2017
Citation: Shen MY, Yang KY, Zhou Y (2017) Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials. Immunotherapy (Los Angel) 3:144. doi: 10.4172/2471-9552.1000144
Copyright: © 2017 Shen MY, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Aim: This meta-analysis was conducted to evaluate the safety and efficacy of laparoscopic (LPS) versus open surgery for resectable rectal cancer.
Methods: We analyzed and compared oncological outcomes, safety outcomes, and recovery outcomes between LPS surgery and open surgery. Meta-analyses were conducted using RevMan 5.3 software. Dichotomous variables were analyzed by risk ratio with 95% confidence intervals, and continuous variables were analyzed as mean differences.
Results: A total of 16 randomized controlled trials were identified involving 5386 patients. Based on the currently limited evidence, LPS surgery showed similar oncological outcomes to open surgery in terms of lymph nodes retrieved, positive circumferential resection, incomplete total mesorectal excision, local recurrence, distant metastasis, and unsuccessful resection. LPS surgery was associated with better recovery than open surgery in terms of earlier first bowel movement, earlier start of fluid intake, and shorter hospital stay. However, there was no significant difference in perioperative mortality, re-operation, chest infection, anastomotic leakage, urinary injury, or incision hernia between the LPS and open surgery groups. Importantly, LPS surgery was associated with less intraoperative bleeding, wound infection, and bowel obstruction.
Conclusion: Though the overall quality of LPS seems higher than that of open surgery, there is still insufficient evidence to recommend its routine application. However, its similar oncological outcomes, better recovery, and fewer complications suggests that LPS TME may represent a good option for experienced centers or surgeons.