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Systematic Reviews
Published in: Systematic Reviews 1/2012

Open Access 01-12-2012 | Research

The quality of research synthesis in surgery: the case of laparoscopic surgery for colorectal cancer

Authors: Guillaume Martel, Suleena Duhaime, Jeffrey S Barkun, Robin P Boushey, Craig R Ramsay, Dean A Fergusson

Published in: Systematic Reviews | Issue 1/2012

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Abstract

Background

Several systematic reviews and meta-analyses populate the literature on the effectiveness of laparoscopic surgery for colorectal cancer. The utility of this body of work is unclear. The objective of this study was to synthesize all such systematic reviews in terms of clinical effectiveness, to appraise their quality, and to determine whether areas of duplication exist across reviews.

Methods

Systematic reviews comparing laparoscopic and open surgery for colorectal cancer were identified using a comprehensive search protocol (1991 to 2008). The primary outcome was overall survival. The methodological quality of reviews was appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Abstraction and quality appraisal was carried out by two independent reviewers. Reviews were synthesized, and outcomes were compared qualitatively. A citation analysis was carried out using simple matrices to assess the comprehensiveness of each review.

Results

In total, 27 reviews were included; 13 reviews included only randomized controlled trials. Rectal cancer was addressed exclusively by four reviews. There was significant overlap between review purposes, populations and, outcomes. The mean AMSTAR score (out of 11) was 5.8 (95% CI: 4.6 to 7.0). Overall survival was evaluated by ten reviews, none of which found a significant difference. Three reviews provided a selective meta-analysis of time-to-event data. Previously published systematic reviews were poorly and highly selectively referenced (mean citation ratio 0.16, 95% CI: 0.093 to 0.22). Previously published trials were not comprehensively identified and cited (mean citation ratio 0.56, 95% CI: 0.46 to 0.65).

Conclusions

Numerous overlapping systematic reviews of laparoscopic and open surgery for colorectal cancer exist in the literature. Despite variable methods and quality, survival outcomes are congruent across reviews. A duplication of research efforts appears to exist in the literature. Further systematic reviews or meta-analyses are unlikely to be justified without specifying a significantly different research objective. This works lends support to the registration and updating of systematic reviews.
Appendix
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Metadata
Title
The quality of research synthesis in surgery: the case of laparoscopic surgery for colorectal cancer
Authors
Guillaume Martel
Suleena Duhaime
Jeffrey S Barkun
Robin P Boushey
Craig R Ramsay
Dean A Fergusson
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2012
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/2046-4053-1-14

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Clarifying differences between review designs and methods

Protocol

Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children