Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes

Huang, Meijin; Liang, Jingtao; Wang, Hui; Kang, Liang; Deng, Yanhong; Wang, Jianping

doi:10.1007/s00384-010-1091-6

Cited by 117 publications

(81 citation statements)

References 41 publications

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“…Importantly, analysis of the RCTs included in our study indicated that LPS surgery had similar oncological outcomes to open surgery in terms of OS and disease-free survival [6,8,11,12,14]. Moreover, previous meta-analyses also demonstrated that LPS surgery offered equivalent oncological outcomes to open surgery [18][19][20][21][22][23]. Further studies are needed to validate these results.…”

Section: Discussionsupporting

confidence: 58%

Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials

Shen¹,

Yang²,

Zhou³

2017

Immunotherapy

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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.

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Section: Discussionsupporting

confidence: 58%

Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials

Shen¹,

Yang²,

Zhou³

2017

Immunotherapy

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“…For rectal cancer, 9 phase III randomized clinical trials 11,20,21,[33][34][35][36][37][38][39][40][41][42] and 7 meta-analyses were selected. 28,29,[43][44][45][46][47] No meeting abstracts satisfied the inclusion criteria. The main design characteristics of each randomized trial are summar ized in Table 2 for colon cancer and in Table 3 (Table 1).…”

Section: Researchmentioning

confidence: 99%

Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

et al. 2013

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Background: Adoption of the laparoscopic approach for colorectal cancer treatment has been slow owing to initial case study results suggesting high recurrence rates at port sites. The use of laparoscopic surgery for colorectal cancer still raises a number of concerns, particularly with the technique's complexity, learning curve and longer duration. After exploring the scientific literature comparing open and laparoscopic surgery for the treatment of colorectal cancer with respect to oncologic efficacy and shortterm outcomes, the Comité de l'évolution des pratiques en oncologie (CEPO) made recommendations for surgical practice in Quebec.Methods: Scientific literature published from January 1995 to April 2012 was reviewed. Phase III clinical trials and meta-analyses were included.Results: Sixteen randomized trials and 10 meta-analyses were retrieved. Analysis of the literature confirmed that for curative treatment of colorectal cancer, laparoscopy is not inferior to open surgery with respect to survival and recurrence rates. Moreover, laparoscopic surgery provides short-term advantages, including a shorter hospital stay, reduced analgesic use and faster recovery of intestinal function. However, this approach does require a longer operative time.

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“…A recent meta-analysis by Huang et al [3] to assess the oncologic adequacy of resection and the oncologic outcomes after laparoscopic versus open surgery for rectal cancer showed that laparoscopic surgery is comparable to open surgery in terms of anatomopathological findings and the local recurrence rate, although no data about the prognostic role of lymphadenectomy were given. To our best knowledge, no clinical trials have analyzed the risk factors for local recurrence, disease-free survival, and overall survival after laparoscopic TME for extraperitoneal rectal cancer over a 5-year minimum follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…Developed and popularized by Heald and co worker [1], total mesorectal excision (TME) is presently the surgical gold standard, with a 4 % local recurrence rate and a 78 % tumor-free survival rate in curative cases at 5 years [2]. A recent meta-analysis by Huang et al [3] of randomized controlled trials that included small numbers of patients with upper or mid-to-low rectal cancer did not show differences between laparoscopic and open surgery in terms of the number of lymph nodes (LN) harvested, local recurrence, 3-year disease-free survival, and overall survival. Although a minimum of 12 LN in the…”

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confidence: 99%

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

et al. 2012

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BackgroundThe lymph node ratio (LNR; number of positive nodes divided by total nodes harvested) has been demonstrated to be a prognostic factor in colon cancer, but its role in extraperitoneal rectal cancer is still debated; furthermore, no data are available on laparoscopic rectal resection. The aim of this study was to evaluate the prognostic impact of LNR on long-term outcomes after laparoscopic total mesorectal excision (LTME) for extraperitoneal cancer in consecutive patients with a 5-year minimum follow-up. Methods This study is a prospective analysis of consecutive patients who underwent LTME for adenocarcinoma of the extraperitoneal rectum. Results LTME was performed in 158 patients. The median number of LN harvested was 12 (range = 3-25). The proportion of specimens with fewer than 12 examined LN was significantly higher in patients who had neoadjuvant chemoradiotherapy (p < 0.001). During a median follow-up period of 122 months, the local recurrence rate was 8 %. At univariate analysis, disease-free survival and overall survival significantly decreased with increasing LNR (p < 0.001). Multivariate analysis showed that the distal margin ≤1 cm was the only independent predictor of local recurrence (p = 0.028). LNR (cutoff value = 0.25) and lymphovascular invasion were significant prognostic factors for both disease-free (p = 0.015 and p = 0.046, respectively) and overall survival (p = 0.031 and p = 0.040, respectively). Even in the subgroup of patients in whom fewer than 12 LN were examined, LNR confirmed its prognostic role, with a statistical trend toward worse disease-free survival and overall survival. Conclusion Metastatic LNR is an independent prognostic factor for disease-free survival and overall survival after LTME for extraperitoneal rectal cancer. Keywords Lymph node ratio Survival Laparoscopy Total mesorectal excision Rectal cancer Excellence of surgical technique is of particular relevance in the treatment of extraperitoneal rectal cancer. Routine excision of the intact mesorectum during resection of cancer of the middle and lower rectum has resulted in a significant decrease in local recurrence rates [1]. Developed and popularized by Heald and co worker [1], total mesorectal excision (TME) is presently the surgical gold standard, with a 4 % local recurrence rate and a 78 % tumor-free survival rate in curative cases at 5 years [2]. A recent meta-analysis by Huang et al. [3] of randomized controlled trials that included small numbers of patients with upper or mid-to-low rectal cancer did not show differences between laparoscopic and open surgery in terms of the number of lymph nodes (LN) harvested, local recurrence, 3-year disease-free survival, and overall survival. Although a minimum of 12 LN in the

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Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes

Cited by 117 publications

References 41 publications

Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials

Laparoscopic versus Open Total Mesorectal Excision for Resectable Rectal Cancer: An Updated Meta-analysis of Randomized Controlled Trials

Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

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