The comprehensive therapeutic effects of rectal surgery are better in laparoscopy: a systematic review and meta-analysis

Background: Laparoscopic-assisted radical resection of rectal cancer was reported as advantageous compared to laparotomy resection. However, this finding remains controversial, especially given the two recent randomized controlled trials published on The Journal of the American Medical Association (JAMA).

Objective: To perform a meta-analysis that compares the short-term and long-term outcomes of laparoscopic and open surgery for rectal cancer.

Data source: To identify clinical trials comparing laparoscopic and open surgery for rectal cancer published by August 2016, we searched the PubMed, Cochrane Library, Springer Link and Clinicaltrials.gov databases by combining various key words. Data were extracted from every identified study to perform a meta-analysis using the Review Manager 5.3 software.

Results: A total of 43 articles from 38 studies with a total of 13408 patients were included. Although laparoscopic radical rectectomy increased operation time (MD = 37.23, 95% CI: 28.88 to 45.57, P < 0.0001), it can significantly decrease the blood loss (MD = -143.13, 95% CI: -183.48 to -102.78, P < 0.0001), time to first bowel movement (MD = -0.97, 95% CI: -1.35 to -0.59, P < 0.0001), length of hospital stay (MD = -2.40, 95% CI: -3.10 to -1.70, P < 0.0001), postoperative complications (OR = 0.78, 95% CI: 0.72 to 0.86, P < 0.0001), mortality (OR = 0.40, 95% CI: 0.28 to 0.57, P < 0.0001) and the CRM positive rate (OR = 0.64, 95% CI: 0.55 to 0.75, P < 0.0001). No significant difference were noted between the groups regarding intraoperative complications, TME completeness and harvesting of lymph nodes. Regarding the long-term survival data, the laparoscopic group was not inferior to laparotomy. Some pooled data, such as 3-year DFS, 5-year OS and 5-year local recurrence were even superior for the laparoscopic group.

Conclusions: Given the definite benefits in short-term outcomes and trending benefits in long-term outcomes that were observed, we recommend laparoscopic surgery be used for rectal cancer resection.