Oncological safety of laparoscopic versus open colorectal cancer surgery in obesity: a systematic review and meta‐analysis

Abstract

Background Colorectal cancer resection in the obese (OB) patients can be technically challenging. With the increasing adoption of laparoscopic surgery, the benefits remain uncertain. Hence, the aim of this study is to assess the short‐ and long‐term outcomes of laparoscopic compared to open colorectal cancer resection in the OB patients. Methods A systematic review and meta‐analysis was performed according to the PRISMA guidelines. The outcome measures were 5‐year disease‐free survival, overall survival, circumferential resection margin and local and distant recurrence. Results A total of 20 studies were included, with a total number of 6779 participants, of whom 1785 (26.3%) were OB and 4994 (73.7%) were non‐obese (NOB) participants. The OB patients had higher R1 resection (OB 6.9% versus NOB 3.1%; P = 0.011) and lower mean number of lymph nodes harvested, with standard mean difference of −0.29; P = 0.023, favouring the NOB patients. However, there was no statistical difference for local (OB 2.8% versus NOB 3.4%) or distant recurrence (OB 12.9% versus NOB 15.2%) rate between the two cohorts. There was no difference in 5‐year disease‐free survival (OB 81% versus NOB 77.4%; odds ratio 1.25, P = 0.215) and overall survival (OB 89.4% versus NOB 87.9%; odds ratio 1.16, P = 0.572). Lastly, the OB group had higher mean total blood loss, total operative time and length of hospital stay when compared to NOB patients. Conclusion From a pooled non‐randomized study, laparoscopic colorectal cancer resection is safe in OB patients with equivalent long‐term outcomes compared to NOB patients. However, there is a higher morbidity rate with an increased demand on hospital resources for the OB cohort.

Long-term results of laparoscopic surgery and open surgery for colorectal cancer in Huaihe River Basin of China

“…Open surgery is more traumatic to patients, and postoperative patients have slower recovery and higher complication rates (Zhao et al, 2014). Laparoscopic surgery has been gradually applied to clinical work because of its small trauma, less patient pain, and low postoperative complications (Bellio et al, 2019;Bell et al, 2019;Chiu et al, 2019). However, the anatomical location of the colorectal is more complicated, and laparoscopic surgery may not completely remove the lesion, resulting in a higher recurrence rate (Hamabe et al, 2019;Igder et al, 2020).…”

Impact of Excess Body Weight on Postsurgical Complications

“…Bell et al [42] focused on the oncological outcome of obese patients undergoing colorectal surgery. They found obesity to be a predictor for slightly higher tumor-positive resection margins (R1) with 6.9% in the obese versus 3.1% in the nonobese group.…”

“…The vast majority of open and/or complex oncologic procedures in the field of visceral surgery have shown higher complication rates in obese patients [4]. Meta-analyses from the last 10 to 15 years with high numbers of patients enrolled consistently have shown higher operation times, higher blood loss, longer hospital stay for colorectal procedures [42], oncologic upper GI procedures [47], and pancreatic surgery [58]. Interestingly, these negative effects seem not to affect the overall survival in oncologic patients, especially in esophageal resections.…”

The feasibility and safety of complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer

“…According to the International Agency for Research on Cancer (IARC), over 1.8 million new colorectal cancer cases and 881,000 deaths were estimated to occur in 2018, and colorectal cancer ranked third in terms of cancer incidence and second in terms of cancer mortality [ 1 ]. The surgical treatment for colorectal cancer has improved significantly with technical advances and theoretical progress [ 2 ], while the surgical procedures for transverse colon cancer can be controversial because of the location of the tumor [ 3 , 4 ]. For right-transverse colon cancer, the conventional surgical procedure is laparoscopic extended hemicolectomy with extracorporeal anastomosis.…”