Laparoscopic versus open total mesorectal excision for rectal cancer

Colorectal cancer including rectal cancer is the third most cause of cancer deaths in the western world. For colon carcinoma, surgery is proven to result in faster postoperative recovery, fewer and better cosmetic results with equal oncologic results. These short- benefits are expected to be similar for laparoscopic rectal cancer However, the oncological safety of laparoscopic surgery for rectal remained controversial due to the lack of definitive long-term results. expected short-term benefits can only be of interest when oncological at least equal. OBJECTIVES: To evaluate the differences in short- and results after elective laparoscopic total mesorectal excision (LTME) for resection of rectal cancer compared with open total mesorectal excision SEARCH METHODS: We searched the Cochrane Central Register of Controlled (CENTRAL, The Cochrane Library 2013, Issue 2), MEDLINE (January 1990 to 2013), EMBASE (January 1990 to February 2013), ClinicalTrials.gov and Current Controlled Trials (February 2013). We handsearched the lists of the included articles for missed studies. SELECTION CRITERIA: randomised controlled trials (RCTs) comparing LTME and OTME, reporting one of our outcome measures, was considered for inclusion. DATA ANALYSIS: Two authors independently assessed study quality according to CONSORT statement, and resolved disagreements by discussion. We rated of the evidence using GRADE methods. MAIN RESULTS: We identified 45 out of 953 search results, of which 14 studies met the inclusion involving 3528 rectal cancer patients. We did not consider the risk of the included studies to have impacted on the quality of the evidence. analysed according to an intention-to-treat principle with a mean of 14.5% (range 0% to 35%) in the laparoscopic group.There was moderate evidence that laparoscopic and open TME had similar effects on five-year disease-free survival (OR 1.02; 95% CI 0.76 to1.38, 4 studies, N = 943). estimated effects of laparoscopic and open TME on local recurrence and survival were similar, although confidence intervals were wide, both moderate quality evidence (local recurrence: OR 0.89; 95% CI 0.57 to1.39 overall survival rate: OR 1.15; 95% CI 0.87 to1.52). There was moderate quality evidence that the number of resected lymph nodes and surgical were similar between the two groups.For the short-term results, length hospital stay was reduced by two days (95% CI -3.22 to -1.10), moderate evidence), and the time to first defecation was shorter in the LTME days; 95% CI -1.17 to -0.54). There was moderate quality evidence that morbidity were similar in both groups (OR 0.94; 95% CI 0.8 to 1.1). fewer wound infections (OR 0.68; 95% CI 0.50 to 0.93) and fewer bleeding complications (OR 0.30; 95% CI 0.10 to 0.93) in the LTME group.There was evidence of any differences in quality of life after LTME or OTME functional recovery, bladder and sexual function. The costs were higher with differences up to GBP 2000 for direct costs only. AUTHORS' have found moderate quality evidence that laparoscopic total mesorectal (TME) has similar effects to open TME on long term survival outcomes for treatment of rectal cancer. The quality of the evidence was downgraded imprecision and further research could impact on our confidence in this There is moderate quality evidence that it leads to better short-term post-surgical outcomes in terms of recovery for non-locally advanced cancer. Currently results are consistent in showing a similar disease- survival and overall survival, and for recurrences after at least three up to 10 years, although due to imprecision we cannot rule out either approach. We await long-term data from a number of ongoing and completed studies to contribute to a more robust analysis of long-term free, overall survival and local recurrence.