Laparoscopic surgery for colorectal cancer: safe and effective? – A systematic review
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To determine the clinical effectiveness of laparoscopic and laparoscopically assisted surgery in comparison with open surgery for the treatment of colorectal cancer.
Open resection is the standard method for surgical removal of primary colorectal tumours. However, there is significant morbidity associated with this procedure. Laparoscopic resection (LR) is technically more difficult but may overcome problems associated with open resections (OR).
Systematic review and meta-analysis of short- and long-term data from randomised controlled trials (RCTs) comparing LS with OR.
Highly sensitive searches of nine databases identified 19 primary RCTs describing data from over 4,500 participants. Length of hospital stay is shorter, blood loss and pain are less, and return to usual activities is likely to be faster after LR than after OR, but duration of operation is longer. Lymph node retrieval, completeness of resection and quality of life do not appear to differ. No statistically significant differences were observed in rates of anastomotic leakage, abdominal wound breakdown, incisional hernia, wound and urinary tract infections, operative and 30-day mortality, and recurrences, nor in overall and disease-free survival up to three years.
LR is associated with a quicker recovery in terms of return to usual activities and length of hospital stay with no evidence of a difference in complications or long-term outcomes in comparison to OR, up to three years postoperatively.
KeywordsColorectal cancer Laparoscopic surgery Systematic review Meta-analysis
The authors are thankful to information officer Cynthia Fraser for undertaking the searches and secretarial support from Bronwyn Davidson. Work on the review was supported by a grant from the National Institute for Health and Clinical Excellence. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Executive Health Department. The views expressed in this paper are those of the authors not the institutions providing funding.
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