A systematic review and meta-analysis evaluating the role of laparoscopic surgical resection of transverse colon tumours
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A meta-analysis of published literature comparing outcomes after laparoscopic resection (LR) with open resection (OR) for transverse colon tumours.
Medline, PubMed, CINAHL, EMBASE and Cochrane were searched from inception to October 2013. The text words “minimally invasive”, “keyhole surgery” and “transverse colon” were used in combination with the medical subject headings “laparoscopy” and “colon cancer”. Outcome variables were chosen based upon whether the included articles reported results. A meta-analysis was performed to obtain a summative outcome.
Six comparatives involving 444 patients were analysed. Of them 245 patients were in the LR group and 199 in the OR group. There was a significant increase in operative time in the LR group compared with the OR group [random effects model: SMD = −0.65, 95 % CI (−1.01, −0.30), z = −3.60, p < 0.001] but there was significant heterogeneity amongst trials (Q = 15.51, df = 5, p = 0.008, I 2 = 68). There was less blood loss in the LR group [fixed effects model: SMD = 0.70, 95 % CI (0.47, 0.93), z = 6.01, p < 0.001] and patients returned to oral diet earlier [random effects model: SMD = 0.78, 95 % CI (0.40, 1.16), z = 4.01, p < 0.001] and had a reduced time to functioning bowel [fixed effects model: SMD = 0.86, 95 % CI (0.60, 1.11), z = 6.63, p < 0.001]. No difference was seen for overall morbidity (p = 0.76) or mortality (p = 0.58).
LR of transverse colon tumours is a safe and effective technique. Although there is an increase in operating time, operative and clinical outcomes of intraoperative blood loss and faster recovery are seen with laparoscopic procedures.
KeywordsLaparoscopy Transverse colon tumours Colorectal cancer Surgery Outcomes
Chand M, Siddiqui MRS, Rasheed S, Brown G, Tekkis P, Parvaiz A, Qureshi T have no conflict of interests.
- 3.Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection Cochrane Database Syst Rev 3:CD003145Google Scholar
- 4.Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (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
- 8.Braga M, Vignali A, Zuliani W, Frasson M, Di Serio C, Di Carlo V (2005) Laparoscopic versus open colorectal surgery: cost-benefit analysis in a single-center randomized trial Ann Surg: 242:890–895 (discussion 5–6)Google Scholar
- 10.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700PubMedCentralPubMedCrossRefGoogle Scholar
- 18.Rangel SJ, Kelsey J, Colby CE, Anderson J, Moss RL.(2003) Development of a quality assessment scale for retrospective clinical studies in pediatric surgery J Pediatr Surg 38:390–396 (discussion-6)Google Scholar
- 19.http://www.sign.ac.uk/guidelines/fulltext/50/checklist3.html. SIGN Guidelines. 2009 [updated March 2009; cited 2013 10th October]
- 25.Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD003432.pub2