Journal of Gastrointestinal Surgery

, Volume 22, Issue 8, pp 1418–1433 | Cite as

Short- and Long-Term Oncological Outcome After Rectal Cancer Surgery: a Systematic Review and Meta-Analysis Comparing Open Versus Laparoscopic Rectal Cancer Surgery

  • Henrik Nienhüser
  • Patrick Heger
  • Robin Schmitz
  • Yakup Kulu
  • Markus K. Diener
  • Johannes Klose
  • Martin Schneider
  • Beat P. Müller-Stich
  • Alexis Ulrich
  • Markus W. Büchler
  • Andre L. Mihaljevic
  • Thomas Schmidt
Original Article



While several trials have compared laparoscopic to open surgery for colon cancer showing similar oncological results, oncological quality of laparoscopic versus open rectal resection is not well investigated.


A systematic literature search for randomized controlled trials was conducted in MEDLINE, the Cochrane Library, and Embase. Qualitative and quantitative meta-analyses of short-term (rate of complete resections, number of harvested lymph nodes, circumferential resection margin positivity) and long-term (recurrence, disease-free and overall survival) oncologic results were conducted.


Fourteen randomized controlled trials were identified including 3528 patients. Patients in the open resection group had significantly more complete resections (OR 0.70; 95% CI 0.51–0.97; p = 0.03) and a higher number of resected lymph nodes (mean difference − 0.92; 95% CI − 1.08 to 0.75; p < 0.001). No differences were detected in the frequency of positive circumferential resection margins (OR 0.82; 95% CI 0.62–1.10; p = 0.18). Furthermore, no significant differences of long-term oncologic outcome parameters after 5 years including locoregional recurrence (OR 0.95; 95% CI 0.44–2.05; p = 0.89), disease-free survival (OR 1.16; 95% CI 0.84–1.58; p = 0.36), and overall survival (OR 1.04; 95% CI 0.76–1.41; p = 0.82) were found. Most trials exhibited a relevant risk of bias and several studies provided no information on the surgical expertise of the participating surgeons.


Differences in oncologic outcome between laparoscopic and open rectal surgery for rectal cancer were detected for the complete resection rate and the number of resected lymph nodes in favor of the open approach. No statistically significant differences were found in oncologic long-term outcome parameters.


Rectal cancer Laparoscopic surgery Systematic review Meta-analysis 


Authors’ Contribution

HN, PH, RS, BPM, ALM, and TS are responsible for the conception and design of the study. HN, PH, RS, ALM, and TS performed the acquisition and analysis of the data and drafted the manuscript. YK, MKD, JK, MS, BPM, AU, and MWB offered substantial contributions to the interpretation of the data and critically revised the manuscript. All authors gave their final approval of this version of the manuscript and are accountable for all aspects of the work.

Funding Information

No funding was used to create this review. However, the resources and facilities of the University of Heidelberg were used in conducting this study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2018_3738_MOESM1_ESM.docx (67 kb)
ESM 1 (DOCX 67 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Henrik Nienhüser
    • 1
  • Patrick Heger
    • 1
    • 2
  • Robin Schmitz
    • 1
    • 3
  • Yakup Kulu
    • 1
  • Markus K. Diener
    • 1
    • 2
  • Johannes Klose
    • 1
  • Martin Schneider
    • 1
  • Beat P. Müller-Stich
    • 1
  • Alexis Ulrich
    • 1
  • Markus W. Büchler
    • 1
  • Andre L. Mihaljevic
    • 1
    • 2
  • Thomas Schmidt
    • 1
  1. 1.Department of General, Visceral and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Study Center of the German Surgical Society (SDGC)University of HeidelbergHeidelbergGermany
  3. 3.Department of SurgeryDuke University Medical CenterDurhamUSA

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