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Medical Oncology

, Volume 28, Issue 4, pp 925–933 | Cite as

A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer

  • Yanlei Ma
  • Zhe YangEmail author
  • Huanlong QinEmail author
  • Yu WangEmail author
Original Paper

Abstract

The aim of this study was to compare the outcome of the overall complication, mortality, and recurrence rate between laparoscopic resection and open surgery for colorectal cancer. We searched the Medline, Embase, and Cochrane Library and systematically reviewed the randomized controlled trials by comparing the overall complication, mortality, and recurrence rate between laparoscopic resection and open surgery for colorectal cancer. Fifteen trials with 4,207 patients who reported long-term outcomes of the overall complication, mortality, and recurrence rate were included. The combined results of the individual trials showed no statistically significant difference in the odds ratio (OR) for overall recurrence (OR 0.92, 95% CI, 0.77–1.11, P = 0.34), local recurrence (OR 0.81, 95% CI, 0.59–1.12, P = 0.20), distant metastasis (OR 1.01, 95% CI, 0.78–1.30, P = 0.95), wound-site recurrence (OR 1.97, 95% CI, 0.77–5.02, P = 0.16), colorectal cancer-related mortality (OR 0.82, 95% CI, 0.66–1.02, P = 0.07), colon cancer-related mortality (OR 0.85, 95% CI, 0.66–1.09, P = 0.20), rectal cancer-related mortality (OR 0.76, 95% CI, 0.53–1.11, P = 0.16), and overall mortality (OR 0.87, 95% CI, 0.73–1.73, P = 0.11) between the laparoscopic surgery and open surgery groups. The overall complications in the laparoscopic surgery group were much lower than that in the open surgery group (OR 0.71, 95% CI, 0.58–0.87, P = 0.001). This meta-analysis showed that the successful laparoscopic colorectal resection for colorectal cancer was as effective as open surgery in terms of the oncological outcomes, thereby suggesting that laparoscopic surgery can be continued in patients with colorectal cancer.

Keywords

Meta-analysis Colorectal cancer Surgery 

References

  1. 1.
    Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.CrossRefGoogle Scholar
  2. 2.
    The Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med. 1991;324:1073–8.CrossRefGoogle Scholar
  3. 3.
    Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA. Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long-term outcome. Surg Endosc. 2000;14:1062–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Soper NJ, Brunt LM, Kerbl K. Laparoscopic general surgery. N Engl J Med. 1994;330:409–19.PubMedCrossRefGoogle Scholar
  5. 5.
    Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D. Laparoscopic colectomy. Ann Surg. 1992;216:703–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Kehlet H. Surgical stress response: does endoscopic surgery confirm an advantage? World J Surg. 1999;23:801–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg. 2004;91:1111–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschieri A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL. Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc. 2004;18:1163–85.PubMedCrossRefGoogle Scholar
  9. 9.
    Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW. Fewer adhesions induced by laparoscopic surgery? Surg Endosc. 2004;18:898–906.PubMedCrossRefGoogle Scholar
  10. 10.
    Dupree HJ, Senagore AJ, Delaney CP, Fazio VW. Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg. 2003;197:177–81.CrossRefGoogle Scholar
  11. 11.
    Mirza MS, Longman RJ, Farrokhyar F, Sheffield JP, Kennedy RH. Long-term outcomes for laparoscopic versus open resection of nonmetastatic colorectal cancer. J Laparoendosc Adv Surg Tech A. 2008;18:679–85.PubMedCrossRefGoogle Scholar
  12. 12.
    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. 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. 2003;58:133–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Braga M, Frasson M, Vignali A, Zuliani W, Civelli V, Di Carlo V. Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum. 2005;48:2217–23.PubMedCrossRefGoogle Scholar
  14. 14.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25:3061–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr. Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A. 2004;14:329–34.PubMedGoogle Scholar
  16. 16.
    Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004;363:1187–92.PubMedCrossRefGoogle Scholar
  18. 18.
    Liang JT, Huang KC, Lai HS, Lee PH, Jeng YM. Oncologic results of laparoscopic versus conventional open surgery for stage II or III left-sided colon cancers: a randomized controlled trial. Ann Surg Oncol. 2007;14:109–17.PubMedCrossRefGoogle Scholar
  19. 19.
    Milsom JW, Böhm B, Hammerhofer KA, Fazio V, Steiger E, Elson P. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg. 1998;187:46–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Stage JG, Schulze S, Møller P, Overgaard H, Andersen M, Rebsdorf-Pedersen VB, Nielsen HJ. Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma. Br J Surg. 1997;84:391–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM. Wound complications of laparoscopic vs open colectomy. Surg Endosc. 2002;16:1420–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC. Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc. 2004;18:1211–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Laparoscopic resection of extraperitoneal rectal cancer: a comparative analysis with open resection. Surg Endosc. 2009;23:1818–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised, controlled trial. Lancet. 2005;365:1718–26.PubMedCrossRefGoogle Scholar
  25. 25.
    Yamamoto S, Watanabe M, Hasegawa H, Kitajima M. Oncologic outcome of laparoscopic versus open surgery for advanced colorectal cancer. Hepatogastroenterology. 2001;48:1248–51.PubMedGoogle Scholar
  26. 26.
    Franklin ME Jr, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A. Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis Colon Rectum. 1996;39:S35.PubMedCrossRefGoogle Scholar
  27. 27.
    The Colon Cancer Laparoscopic or Open Resection (COLOR) Study Group. Laparoscopic surgery versus open surgery for colon cancer: Short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.CrossRefGoogle Scholar
  28. 28.
    Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev. 2008;34:498–504.PubMedCrossRefGoogle Scholar
  29. 29.
    Liang Y, Li G, Chen P, Yu J. Laparoscopic versus open colorectal resection for cancer: a meta-analysis of results of randomized controlled trials on recurrence. Eur J Surg Oncol. 2008;34:1217–24.PubMedCrossRefGoogle Scholar
  30. 30.
    Alexander RJT, Jaques BC, Mitchell KG. Laparoscopically assisted colectomy and wound recurrence. Lancet. 1993;341:249–50.PubMedCrossRefGoogle Scholar
  31. 31.
    Wexner SD, Cohen SM. Port-site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg. 1995;82:295–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Pahlman L. The problem of port-site metastases after laparoscopic cancer surgery. Ann Med. 1997;29:477–81.PubMedCrossRefGoogle Scholar
  33. 33.
    Berends FJ, Kazemier G, Bonjer HJ, Lange JF. Subcutaneous metastases after laparoscopic colectomy. Lancet. 1994;344:58.PubMedCrossRefGoogle Scholar
  34. 34.
    Moore J, Hewett P, Penfold JC. Is the port site really at risk? Biology, mechanisms and prevention: a critical view. Aust N Z J Surg. 1999;69:479–85.CrossRefGoogle Scholar
  35. 35.
    Stocchi L, Nelson H. Wound recurrences following laparoscopic-assisted colectomy for cancer. Arch Surg. 2000;135:948–58.PubMedCrossRefGoogle Scholar
  36. 36.
    Vukasin P, Ortega AE, Greene FL, Steele GD, Simons AJ, Anthone GJ, Weston LA, Beart RW Jr. Wound recurrence following laparoscopic colon cancer resection: result of the American Society of Colon and Rectum Surgeons laparoscopic registry. Dis Colon Rectum. 1996;39:S20–3.PubMedCrossRefGoogle Scholar
  37. 37.
    Hoffam GC, Baker JW, Doxey JB, Hubbard GW, Ruffin WK, Wishner JA. Minimally invasive surgery for colorectal cancer: Initial follow-up. Ann Surg. 1996;223:790–8.CrossRefGoogle Scholar
  38. 38.
    Hansbrough JF, Bender EM, Zapata-Sirvent R, Anderson J. Altered helper and suppressor lymphocyte populations in surgical populations in surgical patients: a measure of postoperative immunosuppression. Am J Surg. 1984;148:303–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Decker D, Schondorf M, Bidlingmaier F, Hirner A, von Ruecker AA. Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down regulation of cell mediated and upregulation of antibody-mediated immunity commensurate to the trauma. Surgery. 1996;119:316–25.PubMedCrossRefGoogle Scholar
  40. 40.
    Cole WH. The increase in immunosuppression and its role in the development of malignant lesions. J Surg Oncol. 1985;30:139–44.PubMedCrossRefGoogle Scholar
  41. 41.
    DaCosta ML, Redmond HP, Finnegan N, Flynn M, Bouchier-Hayes D. Laparotomy and laparoscopy differentially accelerate experimental flank tumour growth. Br J Surg. 1998;85:1439–42.CrossRefGoogle Scholar
  42. 42.
    Bouvy ND, Marquet RL, Jeekel J, Bonjer HJ. Laparoscopic surgery is associated with less tumour growth stimulation than conventional surgery: an experimental study. Br J Surg. 1996;84:358–61.CrossRefGoogle Scholar
  43. 43.
    Tang CL, Eu KW, Tai BC, Soh JG, MacHin D, Seow-Choen F. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg. 2001;88:801–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryThe Sixth People’s Hospital Affiliated to Shanghai Jiao Tong UniversityShanghaiPeople’s Republic of China

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