Review
Oncologic outcomes of laparoscopic surgery for rectal cancer: A systematic review and meta-analysis of the literature

https://doi.org/10.1016/j.ejso.2007.11.015Get rights and content

Abstract

Aim

To review and compare the oncologic outcomes in patients with rectal cancer undergoing laparoscopic vs. open rectal surgery.

Methods

An electronic literature search was performed for trials reporting oncologic outcomes for laparoscopic rectal resections. Variables of interest were survival, recurrence rates, margin status and nodal retrieval. Trials were excluded if variables were not specifically analysed for rectal resections. A meta-analysis was performed to assess the difference in oncologic outcomes between the two treatment approaches.

Results

Data on a total of 1403 laparoscopic (LG) and 1755 open (OG) rectal resections were gathered from 24 publications. Overall survival at 3 years (LG = 76%, OG = 69%) was not statistically different between the two treatment groups. The mean local recurrence rates were 7% for laparoscopic and 8% for open procedures (NS). There was no difference in radial margin positivity, 5% of patients undergoing laparoscopic surgery compared to 8% for open surgery. Laparoscopic procedures harvested a mean of 10 nodes as compared to 12 for open procedures, p = 0.001.

Conclusions

Data gathered in this meta-analysis indicate that there are no oncologic differences between laparoscopic and open resections for treatment of primary rectal cancer.

Introduction

Laparoscopic colectomy for colon cancer has been shown in prospective randomised trials to be equivalent to open colectomy in terms of recurrence and survival outcomes.1, 2, 3 In addition, the laparoscopic approach has been found to be associated with improved quality of life compared with traditional open surgery.4, 5

Over the past decade, laparoscopic techniques have also been used for resection of primary rectal cancers. Short-term outcomes have been compared between the open and laparoscopic approach in several randomised prospective trials5, 6, 7, 8, 9, 10, 11 and two recent meta-analyses.12, 13 These studies have shown superior postoperative results in favour of the laparoscopic approach, similar to the findings found with laparoscopic colectomy. However, meta-analyses have been limited to short-term outcomes. There is a growing body of literature reporting oncologic parameters including node and margin status, recurrence rates and overall survival for laparoscopic rectal surgery. These data, however, are fragmented throughout numerous studies, making it difficult to determine the overall effect of laparoscopic techniques on oncologic results for patients undergoing rectal resections. The aim of this study is to present a systematic review of oncologic outcomes in patients undergoing laparoscopic rectal resection for the treatment of rectal cancer and compare these outcomes to those of conventional open resections.

Section snippets

Study selection

Peer-reviewed trials published on laparoscopic rectal resections were found by searching the following databases from 1990 to 2007: Ovid Medline, PubMed, and Cochrane Database of Systematic Reviews. The following search terms were used: “laparoscopy or laparoscop”, “rectal or rect”, “minimally/minimal invasive”, and “cancer or neoplasm or malignancy”. The reference lists of retrieved articles as well as review articles found using the search terms “colorectal” and “cancer or neoplasm or

Study selection

The literature review yielded a total of 47 studies from 1997 through 2007. Twenty-three were excluded, 12 because they were non-comparative trials and 11 because they did not report on the variables of interest. The remaining 24 trials reported survival data, recurrence rates, margin status or node retrieval in patients treated with laparoscopic and open rectal resections for rectal cancer and formed the basis of this analysis. A summary of the trials included in this review is displayed in

Short-term outcomes

With growing data supporting minimally invasive surgery for colorectal cancer,2, 38, 39 there have been several systematic review articles recently published on this topic.40, 41, 42 However, these reviews have combined results for both rectal and colonic resections, and report limited data on long-term oncologic parameters. In the last 3 years, there have been five prospective randomised trials5, 6, 7, 8, 9, 10, 11 comparing short-term outcomes of laparoscopic resections to conventional open

Conclusion

This review of the literature and meta-analysis supports the vast body of literature indicating that there is no difference in oncologic outcomes between laparoscopic vs. open resections for gastrointestinal malignancies. Laparoscopic surgery appears to be suitable for the treatment of rectal cancer as well.

Conflict of interest

The authors have no disclosures.

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