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

Abstract

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.