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Laparoscopic Versus Open Surgery for Mid-Low Rectal Cancer: a Systematic Review and Meta-Analysis on Short- and Long-Term Outcomes

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The safety of laparoscopic surgery for mid-low rectal cancer treatment has remained controversial, especially regarding the long-term outcomes. The aim of this study was to demonstrate whether the laparoscopic technique is feasible.

Methods

We searched all of studies that compared the short- or long-term outcomes regarding laparoscopic and open rectal cancer surgeries (the tumour distance from anal verge within 10 cm). The data sources included PubMed, EMBASE, OVID, Web of Science and the Cochrane Library databases. The combined outcome of the dichotomous variables was expressed as an estimation of the odds ratios and continuous variables were presented in the form of weighted mean differences with 95 % credible intervals. Subgroup, publication bias and sensitivity analyses were performed.

Results

Thirteen studies met the final inclusion criteria (total n = 3,678). The pooled analyses showed, despite longer operation times, that there were significantly less blood loss, fewer transfusions, shorter times to bowel function recovery, resumed diet and hospital durations, and lower overall complication and wound infection rates. The compared results of the lymph node harvest number, distal resection margin, circumferential resection margin involvement, local and distant recurrences, disease-free survival and overall survival were similar between both groups.

Conclusions

This study suggests that the safety and feasibility of laparoscopic surgery appear to be equivalent to open surgery for treatment of mid- low rectal cancer, with the more favourable short-term benefits, fewer complications, comparable pathological outcomes and long-term outcomes.

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Acknowledgments

This work was supported by the grant from the National Natural Science Foundation of China (no. 71203125; 81201391) and grant from the National Natural Science Foundation of Shandong Province (ZR2010HQ031; ZR2011HM070). The funders had no role in study design, data, collection and analysis, decision to publish, or preparation of the manuscript. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China

    Jin-bo Jiang & Yong Dai

  2. School of Medicine, Shandong University, 44/107 Wenhua Xi Road, Jinan, 250012, Shandong, China

    Kun Jiang, Jing-jing Wang & Xue-mei Li

  3. Shandong Academy of Medical Science, Jinan, Shandong, China

    Ru-xia Wang & Wei-zhi Wu

  4. Department of Interventional Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China

    Fu-bo Xie

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  1. Jin-bo Jiang
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Jiang, Jb., Jiang, K., Dai, Y. et al. Laparoscopic Versus Open Surgery for Mid-Low Rectal Cancer: a Systematic Review and Meta-Analysis on Short- and Long-Term Outcomes. J Gastrointest Surg 19, 1497–1512 (2015). https://doi.org/10.1007/s11605-015-2857-5

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