Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials


Background and Aim: Laparoscopic and open rectum surgery for rectal cancer remains controversial.This systematic review compared the short-term and long-term efficiency and complications associated withlaparoscopic and open resection for rectal cancer. Materials and
Methods: We searched PubMed, Embase,Cochrane Library, ISI Web of Knowledge and the China Biology Medicine Database to identify potentialrandomized controlled trials from their inception to March 31, 2014 without language restriction. Additionalarticles were identified from searching bibliographies of retrieved articles. Two reviewers independently assessedthe full-text articles according to the pre-specified inclusion and exclusion criteria as well as the methodologicalquality of included trials. The meta-analysis was performed using RevMan 5.2.
Results: A total of 16 randomizedcontrolled trials involving 3,045 participants (laparoscopic group, 1,804 cases; open group, 1,241 cases) werereviewed. Laparoscopic surgery was associated with significantly lower intraoperative blood loss, earlier returnof bowel movement and reduced length of hospital stay as compared to open surgery, although with increasedoperative time. It also showed an obvious advantage for minimizing late complications of adhesion-related bowelobstruction. Importantly, there were no significant differences in other postoperative complications, oncologicalclearance, 3-year and 5-year or 10 year recurrence and survival rates between two procedures.
Conclusions: Onthe basis of this meta-analysis we conclude that laparoscopic surgery has advantages of earlier postoperativerecovery, less blood loss and lower rates of adhesion-related bowel obstruction. In addition, oncological outcomeis comparable after laparoscopic and open resection for rectal cancer.