International Journal of Colorectal Disease

, Volume 26, Issue 4, pp 415–421

Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes

  • Mei-Jin Huang
  • Jing-Lin Liang
  • Hui Wang
  • Liang Kang
  • Yan-Hong Deng
  • Jian-Ping Wang
Original Article



Whether laparoscopic-assisted surgery (LS) can achieve the same oncologic outcomes compared with open surgery (OS) for rectal cancer remains controversial. The aim of this meta-analysis of randomized controlled trials (RCTs) is to compare oncologic adequacy of resection and long-term oncologic outcomes of LS with OS in the treatment of rectal cancer.


Literature searches of electronic databases (Pubmed, Embase, Web of Science, and Cochrane Library) and manual searches were performed to identify RCTs comparing values of oncologic adequacy of resection, recurrence, and survival following LS and OS.


Six RCTs enrolling 1,033 participants were included in the meta-analysis. LS was associated with similar number of lymph nodes harvested and a similar distal tumor-free margin. LS was associated with a slightly high circumferential resection margin (CRM) positive rate with no significant difference (7.94% vs. 5.37%; risk ratio [RR], 1.13; P = 0.63). There was no significant difference between the two groups in local recurrence (RR, 0.55; P = 0.21). The 3-year overall survival advantage for LS over OS was not statistically significantly different (hazard ratio [HR], 0.76; P = 0.11). The 3-year disease-free survival was not significantly different between the two groups (HR, 1.16; P = 0.64).


The meta-analysis suggests that there are no differences between laparoscopic-assisted and open surgery in terms of number of lymph nodes harvested, involvement of CRM, local recurrence, 3-year overall survival, and disease-free survival for rectal cancer. However, more high-quality studies are needed for further analysis due to the small number of included studies.


Rectal cancer Laparoscopic surgery Open surgery Meta-analysis 


  1. 1.
    Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150PubMedGoogle Scholar
  2. 2.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRefGoogle Scholar
  3. 3.
    Clinical Outcomes of Surgical Therapy Study G (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  4. 4.
    Bonjer HJ, Haglind E, Jeekel I, Kazemier G, Pahlman L, Hop WCJ et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRefGoogle Scholar
  5. 5.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRefGoogle Scholar
  6. 6.
    Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303PubMedCrossRefGoogle Scholar
  7. 7.
    Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P et al (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424PubMedCrossRefGoogle Scholar
  8. 8.
    Gao F, Cao YF, Chen LS (2006) Meta-analysis of short-term outcomes after laparoscopic resection for rectal cancer. Int J Colorectal Dis 21:652–656PubMedCrossRefGoogle Scholar
  9. 9.
    Schiedeck TH, Fischer F, Gondeck C, Roblick UJ, Bruch HP (2005) Laparoscopic TME: better vision, better results? Recent Results Cancer Res 165:148–157PubMedCrossRefGoogle Scholar
  10. 10.
    Lezoche G, Baldarelli M, Guerrieri M, Paganini AM, De Sanctis A, Bartolacci S et al (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22:352–358PubMedCrossRefGoogle Scholar
  11. 11.
    Laurent C, Leblanc F, Wutrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250(1):54–61PubMedCrossRefGoogle Scholar
  12. 12.
    Kim JG, Heo YJ, Son GM, Lee YS, Lee IK, Suh YJ et al (2009) Impact of laparoscopic surgery on the long-term outcomes for patients with rectal cancer. ANZ J Surg 79:817–823PubMedCrossRefGoogle Scholar
  13. 13.
    Morino M, Allaix ME, Giraudo G, Corno F, Garrone C (2005) Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 19:1460–1467PubMedCrossRefGoogle Scholar
  14. 14.
    Engstrom PF, Arnoletti JP, Benson AB 3rd, Chen YJ, Choti MA, Cooper HS et al (2009) NCCN clinical practice guidelines in oncology: rectal cancer. J Natl Compr Canc Netw 7:838–881PubMedGoogle Scholar
  15. 15.
    Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev 34:498–504PubMedCrossRefGoogle Scholar
  16. 16.
    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF et al (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet 354:1896–1900PubMedCrossRefGoogle Scholar
  17. 17.
    D’Annibale A, Morpurgo E, Fiscon V, Termini B, Serventi A, Sovernigo G et al (2006) Minimally invasive resection for colorectal cancer: perioperative and medium-term results in an unselected patient group at a single institution. Tech Coloproctol 10:303–307PubMedCrossRefGoogle Scholar
  18. 18.
    Lundh A, Gotzsche P (2008) Recommendations by cochrane review groups for assessment of the risk of bias in studies. BMC Med Res Methodol 8:22PubMedCrossRefGoogle Scholar
  19. 19.
    Parmar MKB, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834PubMedCrossRefGoogle Scholar
  20. 20.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefGoogle Scholar
  21. 21.
    Egger M, Smith G, Altman D (2001) Systematic reviews in health care: Meta-analysis in context, 2nd edn. BMJ books, LondonCrossRefGoogle Scholar
  22. 22.
    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS et al (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192PubMedCrossRefGoogle Scholar
  23. 23.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar
  24. 24.
    Pechlivanides G, Gouvas N, Tsiaoussis J, Tzortzinis A, Tzardi M, Moutafidis M et al (2007) Lymph node clearance after total mesorectal excision for rectal cancer: laparoscopic versus open approach. Dig Dis 25:94–99PubMedCrossRefGoogle Scholar
  25. 25.
    Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z et al (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215PubMedCrossRefGoogle Scholar
  26. 26.
    Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 187:46–54PubMedCrossRefGoogle Scholar
  27. 27.
    Araujo SE, da Silva eSousa AH Jr, de Campos FG, Habr-Gama A, Dumarco RB, Caravatto PP et al (2003) Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial. Rev Hosp Clin Fac Med Univ Sao Paulo 58:133–140Google Scholar
  28. 28.
    Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50:464–471PubMedCrossRefGoogle Scholar
  29. 29.
    Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989PubMedCrossRefGoogle Scholar
  30. 30.
    Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Hon SS (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum 52:558–566PubMedGoogle Scholar
  31. 31.
    Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY et al (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15:2418–2425PubMedCrossRefGoogle Scholar
  32. 32.
    Doll D, Gertler R, Maak M, Friederichs J, Becker K, Geinitz H et al (2009) Reduced lymph node yield in rectal carcinoma specimen after neoadjuvant radiochemotherapy has no prognostic relevance. World J Surg 33:340–347PubMedCrossRefGoogle Scholar
  33. 33.
    Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D et al (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet (North American Edition) 344:707–711CrossRefGoogle Scholar
  34. 34.
    Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312PubMedCrossRefGoogle Scholar
  35. 35.
    Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRefGoogle Scholar
  36. 36.
    Berends FJ, Kazemier G, Bonjer HJ, Lange JF (1994) Subcutaneous metastases after laparoscopic colectomy. Lancet 344:58PubMedCrossRefGoogle Scholar
  37. 37.
    Neuhaus SJ, Ellis T, Jamieson GG, Watson DI (1999) Experimental study of the effect of intraperitoneal heparin on tumour implantation following laparoscopy. Br J Surg 86:400–404PubMedCrossRefGoogle Scholar
  38. 38.
    Anderson C, Uman G, Pigazzi A (2008) Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur J Surg Oncol 34:1135–1142PubMedGoogle Scholar
  39. 39.
    Le Chevalier T, Scagliotti G, Natale R, Danson S, Rosell R, Stahel R et al (2005) Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes. Lung Cancer 47:69–80PubMedCrossRefGoogle Scholar
  40. 40.
    Green JA, Kirwan JM, Tierney JF, Symonds P, Fresco L, Collingwood M et al (2001) Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 358:781–786PubMedCrossRefGoogle Scholar
  41. 41.
    Buunen M, Bonjer HJ, Hop WCJ, Haglind E, Kurlberg G, Rosenberg J et al (2009) COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer. Dan Med Bull 56:89–91PubMedGoogle Scholar
  42. 42.
    Soop M, Nelson H (2008) Laparoscopic-assisted proctectomy for rectal cancer: on trial. Ann Surg Oncol 15:2357–2359PubMedCrossRefGoogle Scholar
  43. 43.
    Horvath A, Koletzko B, Szajewska H (2007) Effect of supplementation of women in high-risk pregnancies with long-chain polyunsaturated fatty acids on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials. Br J Nutr 98:253–259PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Mei-Jin Huang
    • 1
  • Jing-Lin Liang
    • 1
  • Hui Wang
    • 1
  • Liang Kang
    • 1
  • Yan-Hong Deng
    • 1
  • Jian-Ping Wang
    • 1
  1. 1.Department of Colorectal Surgery, The Sixth Affiliated Hospital (Guangdong Gastrointestinal Hospital)Sun Yat-sen UniversityGuangzhouPeople’s Republic of China

Personalised recommendations