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A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer

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Abstract

The aim of this study was to compare the outcome of the overall complication, mortality, and recurrence rate between laparoscopic resection and open surgery for colorectal cancer. We searched the Medline, Embase, and Cochrane Library and systematically reviewed the randomized controlled trials by comparing the overall complication, mortality, and recurrence rate between laparoscopic resection and open surgery for colorectal cancer. Fifteen trials with 4,207 patients who reported long-term outcomes of the overall complication, mortality, and recurrence rate were included. The combined results of the individual trials showed no statistically significant difference in the odds ratio (OR) for overall recurrence (OR 0.92, 95% CI, 0.77–1.11, P = 0.34), local recurrence (OR 0.81, 95% CI, 0.59–1.12, P = 0.20), distant metastasis (OR 1.01, 95% CI, 0.78–1.30, P = 0.95), wound-site recurrence (OR 1.97, 95% CI, 0.77–5.02, P = 0.16), colorectal cancer-related mortality (OR 0.82, 95% CI, 0.66–1.02, P = 0.07), colon cancer-related mortality (OR 0.85, 95% CI, 0.66–1.09, P = 0.20), rectal cancer-related mortality (OR 0.76, 95% CI, 0.53–1.11, P = 0.16), and overall mortality (OR 0.87, 95% CI, 0.73–1.73, P = 0.11) between the laparoscopic surgery and open surgery groups. The overall complications in the laparoscopic surgery group were much lower than that in the open surgery group (OR 0.71, 95% CI, 0.58–0.87, P = 0.001). This meta-analysis showed that the successful laparoscopic colorectal resection for colorectal cancer was as effective as open surgery in terms of the oncological outcomes, thereby suggesting that laparoscopic surgery can be continued in patients with colorectal cancer.

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References

  1. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.

    Article  Google Scholar 

  2. The Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med. 1991;324:1073–8.

    Article  Google Scholar 

  3. Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA. Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long-term outcome. Surg Endosc. 2000;14:1062–6.

    Article  PubMed  CAS  Google Scholar 

  4. Soper NJ, Brunt LM, Kerbl K. Laparoscopic general surgery. N Engl J Med. 1994;330:409–19.

    Article  PubMed  CAS  Google Scholar 

  5. Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D. Laparoscopic colectomy. Ann Surg. 1992;216:703–7.

    Article  PubMed  CAS  Google Scholar 

  6. Kehlet H. Surgical stress response: does endoscopic surgery confirm an advantage? World J Surg. 1999;23:801–7.

    Article  PubMed  CAS  Google Scholar 

  7. Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg. 2004;91:1111–24.

    Article  PubMed  CAS  Google Scholar 

  8. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschieri A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL. Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc. 2004;18:1163–85.

    Article  PubMed  CAS  Google Scholar 

  9. Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW. Fewer adhesions induced by laparoscopic surgery? Surg Endosc. 2004;18:898–906.

    Article  PubMed  CAS  Google Scholar 

  10. Dupree HJ, Senagore AJ, Delaney CP, Fazio VW. Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg. 2003;197:177–81.

    Article  Google Scholar 

  11. Mirza MS, Longman RJ, Farrokhyar F, Sheffield JP, Kennedy RH. Long-term outcomes for laparoscopic versus open resection of nonmetastatic colorectal cancer. J Laparoendosc Adv Surg Tech A. 2008;18:679–85.

    Article  PubMed  Google Scholar 

  12. Araujo SE, da Silva eSousa AH Jr, de Campos FG, Habr-Gama A, Dumarco RB, Caravatto PP, Nahas SC, da Silva J, Kiss DR, Gama-Rodrigues JJ. 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. 2003;58:133–40.

    Article  PubMed  Google Scholar 

  13. Braga M, Frasson M, Vignali A, Zuliani W, Civelli V, Di Carlo V. Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum. 2005;48:2217–23.

    Article  PubMed  Google Scholar 

  14. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, 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. 2007;25:3061–8.

    Article  PubMed  Google Scholar 

  15. Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr. Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A. 2004;14:329–34.

    PubMed  Google Scholar 

  16. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.

    Article  PubMed  Google Scholar 

  17. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004;363:1187–92.

    Article  PubMed  Google Scholar 

  18. Liang JT, Huang KC, Lai HS, Lee PH, Jeng YM. Oncologic results of laparoscopic versus conventional open surgery for stage II or III left-sided colon cancers: a randomized controlled trial. Ann Surg Oncol. 2007;14:109–17.

    Article  PubMed  Google Scholar 

  19. Milsom JW, Böhm B, Hammerhofer KA, Fazio V, Steiger E, Elson P. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg. 1998;187:46–54.

    Article  PubMed  CAS  Google Scholar 

  20. Stage JG, Schulze S, Møller P, Overgaard H, Andersen M, Rebsdorf-Pedersen VB, Nielsen HJ. Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma. Br J Surg. 1997;84:391–6.

    Article  PubMed  CAS  Google Scholar 

  21. Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM. Wound complications of laparoscopic vs open colectomy. Surg Endosc. 2002;16:1420–5.

    Article  PubMed  CAS  Google Scholar 

  22. Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC. Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc. 2004;18:1211–5.

    Article  PubMed  Google Scholar 

  23. Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Laparoscopic resection of extraperitoneal rectal cancer: a comparative analysis with open resection. Surg Endosc. 2009;23:1818–24.

    Article  PubMed  Google Scholar 

  24. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised, controlled trial. Lancet. 2005;365:1718–26.

    Article  PubMed  Google Scholar 

  25. Yamamoto S, Watanabe M, Hasegawa H, Kitajima M. Oncologic outcome of laparoscopic versus open surgery for advanced colorectal cancer. Hepatogastroenterology. 2001;48:1248–51.

    PubMed  CAS  Google Scholar 

  26. Franklin ME Jr, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A. Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis Colon Rectum. 1996;39:S35.

    Article  PubMed  Google Scholar 

  27. The Colon Cancer Laparoscopic or Open Resection (COLOR) Study Group. Laparoscopic surgery versus open surgery for colon cancer: Short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.

    Article  Google Scholar 

  28. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev. 2008;34:498–504.

    Article  PubMed  Google Scholar 

  29. Liang Y, Li G, Chen P, Yu J. Laparoscopic versus open colorectal resection for cancer: a meta-analysis of results of randomized controlled trials on recurrence. Eur J Surg Oncol. 2008;34:1217–24.

    Article  PubMed  CAS  Google Scholar 

  30. Alexander RJT, Jaques BC, Mitchell KG. Laparoscopically assisted colectomy and wound recurrence. Lancet. 1993;341:249–50.

    Article  PubMed  CAS  Google Scholar 

  31. Wexner SD, Cohen SM. Port-site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg. 1995;82:295–8.

    Article  PubMed  CAS  Google Scholar 

  32. Pahlman L. The problem of port-site metastases after laparoscopic cancer surgery. Ann Med. 1997;29:477–81.

    Article  PubMed  CAS  Google Scholar 

  33. Berends FJ, Kazemier G, Bonjer HJ, Lange JF. Subcutaneous metastases after laparoscopic colectomy. Lancet. 1994;344:58.

    Article  PubMed  CAS  Google Scholar 

  34. Moore J, Hewett P, Penfold JC. Is the port site really at risk? Biology, mechanisms and prevention: a critical view. Aust N Z J Surg. 1999;69:479–85.

    Article  Google Scholar 

  35. Stocchi L, Nelson H. Wound recurrences following laparoscopic-assisted colectomy for cancer. Arch Surg. 2000;135:948–58.

    Article  PubMed  CAS  Google Scholar 

  36. Vukasin P, Ortega AE, Greene FL, Steele GD, Simons AJ, Anthone GJ, Weston LA, Beart RW Jr. Wound recurrence following laparoscopic colon cancer resection: result of the American Society of Colon and Rectum Surgeons laparoscopic registry. Dis Colon Rectum. 1996;39:S20–3.

    Article  PubMed  CAS  Google Scholar 

  37. Hoffam GC, Baker JW, Doxey JB, Hubbard GW, Ruffin WK, Wishner JA. Minimally invasive surgery for colorectal cancer: Initial follow-up. Ann Surg. 1996;223:790–8.

    Article  Google Scholar 

  38. Hansbrough JF, Bender EM, Zapata-Sirvent R, Anderson J. Altered helper and suppressor lymphocyte populations in surgical populations in surgical patients: a measure of postoperative immunosuppression. Am J Surg. 1984;148:303–7.

    Article  PubMed  CAS  Google Scholar 

  39. Decker D, Schondorf M, Bidlingmaier F, Hirner A, von Ruecker AA. Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down regulation of cell mediated and upregulation of antibody-mediated immunity commensurate to the trauma. Surgery. 1996;119:316–25.

    Article  PubMed  CAS  Google Scholar 

  40. Cole WH. The increase in immunosuppression and its role in the development of malignant lesions. J Surg Oncol. 1985;30:139–44.

    Article  PubMed  CAS  Google Scholar 

  41. DaCosta ML, Redmond HP, Finnegan N, Flynn M, Bouchier-Hayes D. Laparotomy and laparoscopy differentially accelerate experimental flank tumour growth. Br J Surg. 1998;85:1439–42.

    Article  CAS  Google Scholar 

  42. Bouvy ND, Marquet RL, Jeekel J, Bonjer HJ. Laparoscopic surgery is associated with less tumour growth stimulation than conventional surgery: an experimental study. Br J Surg. 1996;84:358–61.

    Article  Google Scholar 

  43. Tang CL, Eu KW, Tai BC, Soh JG, MacHin D, Seow-Choen F. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg. 2001;88:801–7.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, 600 Yishan Road, 200233, Shanghai, People’s Republic of China

    Yanlei Ma, Zhe Yang, Huanlong Qin & Yu Wang

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  1. Yanlei Ma
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  2. Zhe Yang
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  3. Huanlong Qin
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  4. Yu Wang
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Corresponding authors

Correspondence to Zhe Yang, Huanlong Qin or Yu Wang.

Additional information

This work was financially supported by the Grants from Shanghai Science and Technology Development Fund (No. 05DJ14010), the Major Basic Research Program of Shanghai (No. 07DZ19505), and the National 973 Basic Research Program of China (No. 2008CB517403).

Yanlei Ma is the first author.

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Ma, Y., Yang, Z., Qin, H. et al. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. Med Oncol 28, 925–933 (2011). https://doi.org/10.1007/s12032-010-9549-5

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