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

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.