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JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Vol. VIII, n 1, June 2021

Pages: 948-965
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Comparison of Short-Term and Long-Term outcomes of Laparoscopy Versus Laparotomy in Rectal Cancer: Systematic Review and Meta-analysis of Randomized Controlled Trials

Author: Lina Boualila, Amine Souadka, Zaineb Benslimane, Laila Amrani, Amine Benkabbou, Mohsine Raouf, Mohamed Anass Majbar

Category: JMSR Oncology

Abstract:

Background and objective: The last randomized controlled trials ,the ACOSOG Z6051 1,2 and the ALaCaRT trial3, 4 could not show the non-inferiority of the laparoscopy in comparison to laparotomy for rectal cancer. In fact, the ten first years of practicing laparoscopy were years when surgeons developed their learning curve. Therefore, by excluding this learning bias, it is possible to end up with a more fair and correct comparison between the two techniques. It is henceforth relevant to pursue a new meta-analysis that compares the two techniques and excludes studies done during the earlier periods of laparoscopic rectal surgery. Results: Six randomized controlled trials met the eligibility criteria, involving a total of 1556 patients in the laparoscopy group and 1188 patients in the laparotomy group. Our meta-analysis was in favor of laparoscopy in a significant way for blood loss, first bowel movement and the number of harvested lymph nodes. It was non-significantly in favour of laparoscopy for 30-days mortality after surgery and length of hospital stay. It was significantly in favor of laparotomy for operative duration. No significant difference was found in anastomotic leakage) , reoperation within 30 days, number of positive CRMs and completeness of mesorectal excision between the two groups. No difference was found in recurrence, disease-free survival and overall survival between laparoscopy group and laparotomy group. Conclusion: The comparison of the randomized controlled trials published before and after 2010, showed no significant difference in outcomes between the learning period and after.

Keywords: Laparoscopy, laparotomy, long-term outcomes, meta-analysis, short-term outcomes, rectal cancer

DOI: 10.46327/msrjg.1.000000000000197

DOI URL: https://doi.org/10.46327/msrjg.1.000000000000197

References:

1. Fleshman, J. et al. Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial. Ann. Surg. 2019; 269 (4): 589–595. doi: 10.1097/SLA.0000000000003002.

2. Fleshman, J. et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA. 2015; 314 (13): 1346–1355. doi: 10.1001/jama.2015.10529.

3. Stevenson, A. R. L. et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA. 2015; 314 (13): 1356–1363. doi: 10.1001/jama.2015.12009.

4. Stevenson, A. R. L. et al. Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Ann. Surg. 2019; 269 (4): 596–602 . doi: 10.1097/SLA.0000000000003021

5. Kienle, P., Weitz, J., Koch, M. & Buchler, M. W. Laparoscopic surgery for colorectal cancer. Colorectal Disease. 2006; VIII Suppl 3: 33–36 . doi: 10.1111/j.1463-1318.2006.01069.x.

6. Milsom, J. W. & Kim, S.-H. Laparoscopic versus Open Surgery for Colorectal Cancer. World Journal of Surgery. 1997; 21 (7): 702–705 . doi: 10.1007/s002689900294

7. Monson JR et al; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2013; 56 (5): 535-50. doi: 10.1097/DCR.0b013e31828cb66c.

8. Website: Laparoscopic Proctectomy for Curable Cancer. Position Statement of the American Society of Colon & Rectal Surgeons (ASCRS) and of the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) www.fascrs.org.

9. Guillou, P. J. et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005; 365 (9472): 1718– 1726 . doi: 10.1016/S0140-6736(05)66545-2

10. Jayne, D. G. et al. Randomized Trial of Laparoscopic-Assisted Resection of Colorectal Carcinoma: 3-Year Results of the UK MRC CLASICC Trial Group. Journal of Clinical Oncology. 2007; 25 (21): 3061–3068 . doi: 10.1200/JCO.2006.09.7758.

11. Arulampalam et al. MRC CLASICC trial. The Lancet. 2005; 366 (9487): 712. DOI: 10.1016/S0140-6736(05)67168-1

12. Website. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.

13. Pas, M. H. van der et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. The Lancet Oncology. 2013; 14 (3): 210–218 . doi: 10.1016/S1470-2045(13)70016-0.

14. Bonjer, H. J. et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N. Engl. J. Med. 2015; 372 (14): 1324–1332. doi: 10.1056/NEJMoa1414882.

15. Kang, S.-B. et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010; 11 (7): 637–645. doi: 10.1016/S1470-2045(10)70131-5.

16. Jeong, S.-Y. et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. The Lancet Oncology. 2014; 15 (7): 767–74. doi: 10.1016/S1470-2045(14)70205-0.

17. Ng, S. S. M. et al. Laparoscopic-assisted versus open total mesorectal excision with anal sphincter preservation for mid and low rectal cancer: a prospective, randomized trial. Surgical Endoscopy. 2014; 28 (1): 297–306. doi: 10.1007/s00464-013-3187-x.

18. Liang, X. et al. Effectiveness and safety of laparoscopic resection versus open surgery in patients with rectal cancer: a randomized, controlled trial from China. J. Laparoendosc. Adv. Surg. Tech. 2011; 21 (5): 381–385. doi: 10.1089/lap.2010.0059.

19. Sterne, J. A. C. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366 : l4898. doi: 10.1136/bmj.l4898.

20. Nagtegaal, I. D. et al. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J. Clin. Oncol. 2002; 20 (7): 1729–1734. doi: 10.1200/JCO.2002.07.010.

21. 7.7.3.5 Medians and interquartile ranges. https://handbook-5-1.cochrane.org/chapter_7/7_7_3_5_mediansand_interquartile_ranges.htm.

22. Table 9.4.a: Summary of meta-analysis methods available in RevMan. https://handbook-5-1.cochrane.org/chapter_9/table_9_4_a_summary_of_meta_analysis_methods_available_in.htm.

23. Arezzo et al. Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg. Endosc.2013; 27 (5): 1485–1502 . doi: 10.1007/s00464-012-2649-x.

24. Pedziwiatr, M. et al. There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes. Tech. Coloproctol. 2017; 21 (8): 595–604. doi: 10.1007/s10151-017-1662-4.

25. Shaw, A. et al. Colorectal surgeons and biomedical scientists improve lymph node harvest in colorectal cancer. Tech. Coloproctol. 2008; 12: 295–298. doi: 10.1007/s10151-008-0438-2.

26. Mekenkamp, L. J. M. et al. Lymph node retrieval in rectal cancer is dependent on many factors--the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am. J. Surg. Pathol. 2009; 33 (10): 1547–1553 . doi: 10.1097/PAS.0b013e3181b2e01f.

27. Acuna, S. A. et al. Laparoscopic Versus Open Resection for Rectal Cancer: A Noninferiority Meta-analysis of Quality of Surgical Resection Outcomes. Ann. Surg. 2019; 269 (5): 849–855 . doi: 10.1097/SLA.0000000000003072.

28. Lu, Y. et al. Comparison Between Laparoscopic and Open Resection Following Neoadjuvant Chemoradiotherapy for Mid-Low Rectal Cancer Patients: A Meta-Analysis. J. Laparoendosc. Adv. Surg. Tech. 2019; 29 (3), 316–322. doi: 10.1089/lap.2018.0409.

29. Nienhüser, H. et al. Short- and Long-Term Oncological Outcome After Rectal Cancer Surgery: a Systematic Review and Meta-Analysis Comparing Open Versus Laparoscopic Rectal Cancer Surgery. J. Gastrointest. Surg. 2018; 22 (8): 1418–1433. doi: 10.1007/s11605-018-3738-5.

30. Memon et al. Meta-analysis of histopathological outcomes of laparoscopic assisted rectal resection (LARR) vs open rectal resection (ORR) for carcinoma. Am. J. Surg. 2018; 216 (5): 1004–1015. doi: 10.1016/j.amjsurg.2018.06.012.

31. Lin, Z. et al. Short- and long-term outcomes of laparoscopic versus open surgery for rectal cancer: A systematic review and meta-analysis of randomized controlled trials. Medicine. 2018; 97 (50): e13704. doi: 10.1097/MD.0000000000013704.

32. Milone, M. et al. Surgical resection for rectal cancer. Is laparoscopic surgery as successful as open approach? A systematic review with meta-analysis. PLoS One. 2018 ; 13 (10): e0204887. doi: 10.1371/journal.pone.0204887.

33. Martínez-Pérez et al. Pathologic Outcomes of Laparoscopic vs Open Mesorectal Excision for Rectal Cancer: A Systematic Review and Meta-analysis. JAMA Surg. 2017; 152 (4): e165665. doi: 10.1001/jamasurg.2016.5665.

34. Martínez-Pérez et al. N. Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: A systematic review and meta-analysis. World J. Gastroenterol. 2017; 23 (44): 7906–7916. doi: 10.3748/wjg.v23.i44.7906.

35. Creavin et al. Meta-analysis of the impact of surgical approach on the grade of mesorectal excision in rectal cancer. Br. J. Surg. 2017; 104 (12): 1609–1619. doi: 10.1002/bjs.10664.

36. Zheng, J. et al. The comprehensive therapeutic effects of rectal surgery are better in laparoscopy: a systematic review and meta-analysis. Oncotarget. 2017; 8 (8): 12717– 12729 . doi: 10.18632/oncotarget.14215.

37. Jiang, J.-B. et al. Short-term and Long-term Outcomes Regarding Laparoscopic Versus Open Surgery for Low Rectal Cancer: A Systematic Review and Meta-Analysis. Surg. Laparosc. Endosc. Percutan. Tech. 2015; 25 (4) : 286–296. doi: 10.1097/SLE.0000000000000178.

38. Arezzo, A. et al. Laparoscopy for rectal cancer is oncologically adequate: a systematic review and meta-analysis of the literature. Surg. Endosc. 2015; 29 (2): 334–348. doi: 10.1007/s00464-014-3686-4.

39. Hua, L. et al. Is the incidence of postoperative anastomotic leakage different between laparoscopic and open total mesorectal excision in patients with rectal cancer? A meta-analysis based on randomized controlled trials and controlled clinical trials. J. Cancer Res. Ther. 2014; 10 Suppl: 272–275. doi: 10.4103/0973-1482.151491.

40. Zhang, F.-W. et al. Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Asian Pac. J. Cancer Prev. 2014; 15 (22) : 9985– 9996. doi: 10.7314/apjcp.2014.15.22.9985.

41. Qu C. et al. [Meta-analysis of laparoscopic versus open total mesorectal excision for middle and low rectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi. 2013; 16 (8): 748– 752. PMID: 23980046

42. Wu et al. Lymph node harvested in laparoscopic versus open colorectal cancer approaches: a meta-analysis. Surg. Laparosc. Endosc. Percutan. Tech. 2012; 22 (1) : 5– 11. doi: 10.1097/SLE.0b013e3182432b49.

43. Trastulli, S. et al. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis. 2012; 14 (6): e277–96. doi: 10.1111/j.1463-1318.2012.02985.x.

44. Xiong, B., Ma, L. & Zhang, C. Laparoscopic versus open total mesorectal excision for middle and low rectal cancer: a meta-analysis of results of randomized controlled trials. J. Laparoendosc. Adv. Surg. Tech. 2012; 22 (7) : 674–684. doi: 10.1089/lap.2012.0143.

45. Ohtani, H. et al. A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for rectal cancer. J. Gastrointest. Surg. 2011; 15 : 1375–1385 . doi: 10.1007/s11605-011-1547-1.

46. Huang, M.-J. et al. Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes. Int. J. Colorectal Dis. 2011; 26 (4): 415–421. doi: 10.1007/s00384-010-1091-6.

47. Anderson, C., Uman, G. & Pigazzi, A. Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur. J. Surg. Oncol. 2008; 34 (10): 1135–1142. doi: 10.1016/j.ejso.2007.11.015.

48. Aziz, O. et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann. Surg. Oncol. 2006; 13 (3): 413–424. DOI: 10.1245/ASO.2006.05.045

49. Simons, A. J. et al. Laparoscopic-assisted colectomy learning curve. Dis. Colon Rectum. 1995; 38 (6): 600–603. doi: 10.1007/BF02054118.