Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 2/2015

01-02-2015 | Review

Laparoscopy for rectal cancer is oncologically adequate: a systematic review and meta-analysis of the literature

Authors: Alberto Arezzo, Roberto Passera, Alessandro Salvai, Simone Arolfo, Marco Ettore Allaix, Guido Schwarzer, Mario Morino

Published in: Surgical Endoscopy | Issue 2/2015

Login to get access

Abstract

Background

This review of cancer outcomes is based on key literature searches of the medical databases and meta-analysis of short-term benefits of laparoscopy in rectal cancer treatment.

Methods

We carried out a systematic review of randomized clinical trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) published between January 2000 and September 2013 listed in the MEDLINE and EMBASE databases (PROSPERO Registration number: CRD42013005076). The primary endpoint was clearance of the circumferential resection margin. Meta-analysis was performed using a fixed-effect model, and sensitivity analysis by a random-effect model; subgroup analysis was performed on subsets of patients with extraperitoneal cancer of the rectum. Relative risk (RR) and mean difference (MD) were used as outcome measures.

Results

Twenty-seven studies (10,861 patients) met the inclusion criteria; eight were RCTs (2,659 patients). The RCTs reported involvement of the circumferential margin in 7.9 % of patients who underwent laparoscopic and in 6.9 % of those undergoing open surgery; the overall RR was 1.00 (95 % confidence interval 0.73–1.35) with no heterogeneity. Subgroup analysis of patients with extraperitoneal cancer showed equivalent involvement of the circumferential margin in the two treatment groups. Although significantly more lymph nodes were retrieved in the surgical specimen after open surgery, the MD of −0.56 was of marginal clinical significance. The sensitivity and subgroup analyses revealed no other significant differences between laparoscopic and open surgery in the rate of R0 resections, distal margin clearance, mesorectal fascia integrity, or local recurrence at 5 years.

Conclusions

Based on the evidence from RCTs and non-RCTs, the short-term benefit and oncological adequacy of laparoscopic rectal resection appear to be equivalent to open surgery, with some evidence potentially pointing to comparable long-term outcomes and oncological adequacy in selected patients with primary resectable rectal cancer.
Literature
1.
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899PubMedCrossRef
2.
Ries LA, Wingo PA, Miller DS et al (2000) The annual report to the nation on the status of cancer, 1973–1997, with a special section on colorectal cancer. Cancer 88:2398–2424PubMedCrossRef
3.
Arezzo A, Passera R, Scozzari G, Verra M, Morino M (2013) Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc 27:1485–1502PubMedCrossRef
4.
Arezzo A, Passera R, Scozzari G, Verra M, Morino M (2013) Laparoscopy for extraperitoneal rectal cancer reduces short-term morbidity: results of a systematic review and meta-analysis. United European Gastroenterol J 1:32–47PubMedCentralPubMedCrossRef
5.
Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef
6.
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRef
7.
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef
8.
Veldkamp R, Kuhry E, Hop WC et al (2005) Colon cancer laparoscopic or open resection study group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRef
9.
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:65–94CrossRef
10.
Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012PubMedCrossRef
11.
Higgins JPT, Green S (editors). Cochrane Handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.​cochrane-handbook.​org. Accessed 1 Jan 2012
12.
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomised studies in meta-analyses. Eur J Epidemiol 25:603–605PubMedCrossRef
13.
14.
15.
Schwarzer G (2007) Meta: an R package for meta-analysis. R News 7:40–45
16.
Wu WX, Sun YM, Hua YB et al (2004) Laparoscopic versus conventional open resection of rectal carcinoma: a clinical comparative study. World J Gastroenterol 10:1167–1170PubMed
17.
Breukink SO, Pierie JP, Grond AJ et al (2005) Laparoscopic versus open total mesorectal excision: a case-control study. Int J Colorectal Dis 20:428–433PubMedCrossRef
18.
Morino M, Allaix ME, Giraudo G, Corno F, Garrone C (2005) Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 19:1460–1467PubMedCrossRef
19.
Veenhof AA, Engel AF, Craanen ME et al (2007) Laparoscopic versus open total mesorectal excision: a comparative study on short-term outcomes. A single-institution experience regarding anterior resections and abdominoperineal resections. Dig Surg 24:367–374PubMedCrossRef
20.
Khaikin M, Bashankaev B, Person B et al (2009) Laparoscopic versus open proctectomy for rectal cancer: patients’ outcome and oncologic adequacy. Surg Laparosc Endosc Percutan Tech 19:118–122PubMedCrossRef
21.
Liang X, Hou S, Liu H, Li Y, Jiang B, Bai W, Li G, Wang W, Feng Y, Guo J (2011) Effectiveness and safety of laparoscopic resection versus open surgery in patients with rectal cancer: a randomised, controlled trial from China. J Laparoendosc Adv Surg Tech A 21:381–385PubMedCrossRef
22.
Laurent C, Leblanc F, Wütrich P et al (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250:54–61PubMedCrossRef
23.
Lujan J, Valero G, Hernandez Q et al (2009) Randomised clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989PubMedCrossRef
24.
Koulas SG, Pappas-Gogos G, Spirou S (2009) Evaluations of laparoscopic proctocolectomy versus traditional technique in patients with rectal cancer. JSLS 13:564–573PubMedCentralPubMedCrossRef
25.
Kang SB, Park JW, Jeong SY et al (2010) 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 11:637–645PubMedCrossRef
26.
Leung KL, Kwok SP, Lau WY, Meng WC, Chung CC, Lai PB, Kwong KH (2000) Laparoscopic-assisted abdominoperineal resection for low rectal adenocarcinoma. Surg Endosc 14:67–70PubMedCrossRef
27.
Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW (2003) Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 46:1047–1053PubMedCrossRef
28.
Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2006) Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis Colon Rectum 49:1108–1115PubMedCrossRef
29.
Lelong B, Bege T, Esterni B, Guiramand J, Turrini O, Moutardier V, Magnin V, Monges G, Pernoud N, Blache JL, Giovannini M, Delpero JR (2007) Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study. Dis Colon Rectum 50:176–183PubMedCrossRef
30.
Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50:464–471PubMedCrossRef
31.
Ströhlein MA, Grützner KU, Jauch KW, Heiss MM (2008) Comparison of laparoscopic versus open access surgery in patients with rectal cancer: a prospective analysis. Dis Colon Rectum 51:385–391PubMedCrossRef
32.
Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol. 15:2418–2425. Erratum in: Ann Surg Oncol 2009;16:229
33.
Baik SH, Gincherman M, Mutch MG, Birnbaum EH, Fleshman JW (2011) Laparoscopic versus open resection for patients with rectal cancer: comparison of perioperative outcomes and long-term survival. Dis Colon Rectum 54:6–14PubMedCrossRef
34.
McKay GD, Morgan MJ, Wong SK, Gatenby AH, Fulham SB, Ahmed KW, Toh JW, Hanna M, Hitos K, South Western Sydney Colorectal Tumour Group (2012) Improved short-term outcomes of laparoscopic versus open resection for colon and rectal cancer in an area health service: a multicenter study. Dis Colon Rectum 55:42–50PubMedCrossRef
35.
Kellokumpu IH, Kairaluoma MI, Nuorva KP, Kautiainen HJ, Jantunen IT (2012) Short- and long-term outcome following laparoscopic versus open resection for carcinoma of the rectum in the multimodal setting. Dis Colon Rectum 55:854–863PubMedCrossRef
36.
Lujan J, Valero G, Biondo S, Espin E, Parrilla P, Ortiz H (2013) Laparoscopic versus open surgery for rectal cancer: results of a prospective multicentre analysis of 4,970 patients. Surg Endosc 27:295–302PubMedCrossRef
37.
van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218PubMedCrossRef
38.
Bretagnol F, Lelong B, Laurent C, Moutardier V, Rullier A, Monges G, Delpero JR, Rullier E (2005) The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 19:892–896PubMedCrossRef
39.
Ng SS, Lee JF, Yiu RY, Li JC, Hon SS, Mak TW, Ngo DK, Leung WW, Leung KL (2013) Laparoscopic-assisted versus open total mesorectal excision with anal sphincter preservation for mid and low rectal cancer: a prospective, randomised trial. Surg Endosc. 7 Sep 2013 [Epub ahead of print]
40.
Seshadri RA, Srinivasan A, Tapkire R, Swaminathan R (2012) Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: a matched case-control study of short-term outcomes. Surg Endosc 26:154–161PubMedCrossRef
41.
Jefferies MT, Evans MD, Hilton J, Chandrasekaran TV, Beynon J, Khot U (2012) Oncological outcome after laparoscopic abdominoperineal excision of the rectum. Colorectal Dis 14:967–971PubMedCrossRef
42.
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150PubMed
43.
Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834PubMedCrossRef
Metadata
Title
Laparoscopy for rectal cancer is oncologically adequate: a systematic review and meta-analysis of the literature
Authors
Alberto Arezzo
Roberto Passera
Alessandro Salvai
Simone Arolfo
Marco Ettore Allaix
Guido Schwarzer
Mario Morino
Publication date
01-02-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3686-4

Other articles of this Issue 2/2015

Surgical Endoscopy 2/2015 Go to the issue

OriginalPaper

The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis: prospective randomized trial

Dynamic Manuscript

Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of a single over-the-scope clip and through-the-scope clips (with videos)

OriginalPaper

Thromboembolic events in bariatric surgery: a large multi-institutional referral center experience

OriginalPaper

Evaluation of advanced laparoscopic skills tasks for validity evidence

OriginalPaper

Laparoscopic Roux limb placement for the management of chronic proximal fistulas after sleeve gastrectomy: technical aspects

OriginalPaper

The effects of acute aerobic exercise on the acquisition and retention of laparoscopic skills