Laparoscopic surgery for colorectal cancer: safe and effective? – A systematic review
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.
- 1.Wanebo HJ editor (1993) Colorectal cancer Mosby, St LouisGoogle Scholar
- 2.Rowan S, Wood H, Cooper N, Quinn M (2005) Update to Cancer Trends for England & Wales 1950–1999 Available at: http://www.statistics.gov.uk/downloads/theme_health/CancerTrendsUpdates.pdf. Accessed June 2005
- 5.National Institute for Clinical Excellence Guidance on the use of laparoscopic surgery for colorectal surgery. Technology appraisal guidance no. 17. Available at: http://www.nice.org.uk/pdf/guidancelapcolcanc.pdf. Accessed June 2005
- 8.Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484PubMedCrossRefGoogle Scholar
- 11.Vardulaki K, Bennett-Lloyd B, Parfitt J, Normond C, Paisley S, Darzi A, Reeves BA systematic review of the effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer. Available at: http://www.nice.org.uk/pdf/HTAreportonlapsurgcoloreccanc.pdf. Accessed June 2005
- 12.Murray A, Lourenco T, de Verteuil R, Hernandez R, Fraser C, McKinley A, Krukowski Z, Vale L, Grant A (2006) Clincal effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation. Health Technol Assess 10(45)Google Scholar
- 13.Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51(12):1235–1241PubMedCrossRefGoogle Scholar
- 18.Araujo SE, da Silva eSousa AH Jr, de Campos FG, Habr-Gama A, Dumarco RB, Caravatto PP, Nahas SC, da Silva J, Kiss DR, Gama-Rodrigues JJ (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 Sao Paulo 58(3):133–140PubMedCrossRefGoogle Scholar
- 25.Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr (2004) Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 14(6):329–334Google Scholar