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Laparoscopic Versus Open Surgery Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: a Systematic Review and Meta-analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

This meta-analysis aimed to evaluate the short-term and pathological outcomes of laparoscopic surgery (LS) versus open surgery (OS) following neoadjuvant chemoradiotherapy (NCRT) for rectal cancer.

Methods

PubMed, Embase, Web of Science, Cochrane Library, and Chinese Biomedicine Literature databases were searched for eligible studies published up to July 2013. The rates of postoperative complication, positive circumferential resection margin (CRM), and the number of lymph nodes harvested were evaluated.

Results

Three randomized controlled trials (RCTs) and five non-RCTs enrolling 953 patients were included. Compared to OS, LS had similar rate of postoperative complication [odds ratio (OR) 0.86; 95 % confidence interval (CI), 0.60 to 1.22], comparable rate of positive CRM (OR 0.41; 95 % CI, 0.16 to 1.02), and smaller number of lymph nodes (weighted mean difference −0.8; 95 % CI, −1.1 to −0.5). LS also had significantly less blood loss, faster bowel movement recovery, and shorter postoperative hospitalization than those of OS.

Conclusion

LS is associated with favorable short-term benefits, similar postoperative complication rate, and comparable pathological outcomes for rectal cancer after NCRT compared to OS despite a slight difference in the number of lymph nodes. Additional high-quality studies are needed to validate long-term outcomes of LS following NCRT.

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Acknowledgments

This study was supported by the Program of Guangdong Provincial Department of Science and Technology (grant no. 2012A030400012) and the Major Program of Science and Technology Program of Guangzhou (grant no. 201300000087).

Conflict of Interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, China

    Hao Chen, Liying Zhao, Jiaming Wu, Zhenhong Zou, Hao Liu & Guoxin Li

  2. Department of Biostatistics, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, China

    Shengli An

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  1. Hao Chen
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  2. Liying Zhao
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  3. Shengli An
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Correspondence to Hao Liu or Guoxin Li.

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Hao Chen and Liying Zhao contributed equally to this work.

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Chen, H., Zhao, L., An, S. et al. Laparoscopic Versus Open Surgery Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: a Systematic Review and Meta-analysis. J Gastrointest Surg 18, 617–626 (2014). https://doi.org/10.1007/s11605-014-2452-1

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