Meta‐analysis of Non‐randomized Comparative Studies of the Short‐term Outcomes of Laparoscopic Resection for Colorectal Cancer

Abstract

Laparoscopic resection remains to be established as the procedure of first choice for operable colorectal cancer. The aim of the study was to conduct a systematic review of non-randomized comparative studies of laparoscopic resection for colorectal cancer. Published work in English was searched for relevant articles published by the end of 2003. The MOOSE statement was used to conduct the meta-analysis. Study quality was assessed by two investigators using the MINORS tool and the analysis was conducted using Comprehensive Meta-analysis software (Biostat, Englewood, NJ, USA) and Microsoft Excel (Microsoft, Redmond, WA, USA). One thousand two hundred and twenty abstracts were reviewed and 398 articles examined in detail. Out of 108 articles reporting the results of relevant studies, 75 were reports of 64 non-randomized comparative studies. Fifteen studies were excluded. Analysis of the outcomes of 6438 resections showed that the conversion rate was 13.3% with a statistically significant difference between studies with more than 50 versus those with 50 or less attempted resections (11.7 vs 16.5%; P<0.001). Laparoscopic resection took 27.6% (41 min) longer to carry out than open resection. There was no significant difference between the two groups in early mortality rates (1.2 vs 1.1%; P=0.787) or likelihood of re-operation (2.3 vs 1.5%; P=0.319). Laparoscopic resection was associated with a lower morbidity rate (24.05 vs 30.80%, odds ratio (95% confidence interval)=0.77 (0.63-0.95); P=0.014, n=4111, random-effects model). Time until passage of first flatus, passage of a bowel motion, tolerating oral fluids and a solid diet was 1.2-1.6 days (26 to 37%) shorter, measurements of pain and narcotic analgesic requirements were 16-35% lower and hospital stay was 3.5 days (18.8%) shorter following laparoscopic resection compared with open resection. The two approaches were 99% similar in terms of adequacy of oncological clearance. Meta-analysis of non-randomized comparative studies favours laparoscopic over open resection for colorectal cancer. The results were remarkably similar to those of a contemporaneous meta-analysis of randomized controlled trials published by the end of 2002.

Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review

“…Conventional MLC has been proven to be oncologically equivalent to OC, in terms of recurrence and survival [53,[60][61][62]. Therefore, any new surgical treatment against colon cancer has to be evaluated in terms of oncological radicalness, compared with MLC, which till nowadays serves as a gold standard [50,[63][64][65][66]. In the present study, all resection margins were free from tumor.…”

Laparoscopic Abdominoperineal Resection for Low Rectal Cancer at National Cancer Hospital of Vietnam

“…However, all patients were successfully operated laparoscopically. Abraham et al reviewed studies, which contained more than 6438 patients of LAR and reported a conversion rate of 7.7% [4]. Shek et al reported a conversion rate of 4% in his series of 99 patients [29].…”

Peri-Operative Care in Colorectal Surgery in the Twenty-First Century

“…Under conventional circumstances, in the first published series of 20 laparoscopic sigmoid colectomies, the authors reported that a five-day hospital stay was achieved in 70% of patients. However, subsequent larger studies including randomized trials reported an average length of stay of about eight days which is still an improvement of about 20% compared with conventional open resections (Abraham et al, 2004(Abraham et al, & 2007Schwenk et al, 2005). The last published large randomized controlled trial of the topic (The ALCCaS) showed no statistically significant difference in postoperative complications, reoperation rate, or perioperative mortality between laparoscopic and open resections (Allardyce et al, 2010).…”

“…Large published studies, randomized trials and meta-analyses suggest an average length of hospital stay of about ten days (Bokey et al, 1995;Abraham et al, 2004Abraham et al, & 2007. In an attempt to mimic the success of laparoscopic gall bladder surgery, laparoscopic colorectal resection was introduced in 1991 as a proposed less invasive alternative to the open technique (Jacobs, 1991;Redwine, 1991).…”