Meta-analysis of randomized controlled trials comparing laparoscopic with open surgery for rectal cancer on oncologic clearance and long-term oncologic outcomes

/Huang Meijin

(黃美近，Dept Col orect Surg，Affil Hosp Guangdong Gastroitest Hosp，Sun Yat-sen Univ，Guangdong 510655)…∥Chin J Gastrointest Surg.-2011，14(8).-606 ～610

ObjectiveTo compare oncologic adequacy of resection and long-term oncologic outcomes between laparoscopic-assisted surgery(LS)and open surgery(OS)in the treatment of rectal cancer.MethodsLiterature searches of electronic databases(PubMed，Embase，Web of Science，and Cochrane Library)and manual searches up to June 30，2010 were performed to identify RCTs comparing values of oncologic adequacy of resection，recurrence and survival following LS and OS.Fixed and random effects models were used.ResultsSix RCTs enrolling 1033 participants(LS group:577 cases，OS group:456 cases)were included in the meta-analysis.Number of lymph node harvested was similar(WMD=-0.38，95%CI:-1.35-0.58，P=0.43).LS had a slightly higher circumference resection margin(CRM)positive rate with no statistical significance［7.94%vs.5.37%;risk ratio(RR)=1.13;95%CI:0.69-1.85，P=0.63］.There was no significant difference between the two groups in local recurrence(RR=0.55;95%CI:0.22-1.40，P=0.21).The 3-year overall survival［Hazard ratio(HR)=0.76;95%CI:0.54-1.07，P=0.11］and 3-year disease-free survival(HR=1.16;95%CI:0.61-2.20，P=0.64)were not significantly different between the two groups.ConclusionCompared with open surgery，laparoscopic surgery of rectal carcinoma offers similar oncological clearance and longterm oncological outcomes.23 refs，6 figs.