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Laparoscopic surgery for colorectal cancer: safe and effective? – A systematic review

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Abstract

Objective

To determine the clinical effectiveness of laparoscopic and laparoscopically assisted surgery in comparison with open surgery for the treatment of colorectal cancer.

Background

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).

Methods

Systematic review and meta-analysis of short- and long-term data from randomised controlled trials (RCTs) comparing LS with OR.

Results

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.

Conclusions

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Health Sciences Building, 3rd Floor Foresterhill, Aberdeen, AB25 2ZD, United Kingdom

    Tania Lourenco, Alison Murray, Adrian Grant & Luke Vale

  2. NHS Grampian, Aberdeen, AB25 2ZD, United Kingdom

    Aileen McKinley & Zygmunt Krukowski

  3. Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, United Kingdom

    Luke Vale

Authors
  1. Tania Lourenco
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  2. Alison Murray
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  3. Adrian Grant
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  4. Aileen McKinley
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  5. Zygmunt Krukowski
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  6. Luke Vale
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Corresponding author

Correspondence to Tania Lourenco.

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Sources of support:

This study was supported by the NHS R&D HTA programme. The Health Services Research Unit and the Health Economics Research Unit are funded by the Chief Scientist Office of the Scottish Executive Health Department. The views expressed here are those of the authors.

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Lourenco, T., Murray, A., Grant, A. et al. Laparoscopic surgery for colorectal cancer: safe and effective? – A systematic review. Surg Endosc 22, 1146–1160 (2008). https://doi.org/10.1007/s00464-007-9686-x

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  • DOI: https://doi.org/10.1007/s00464-007-9686-x

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