The optimal approach of resection for mid–low rectal cancer after neoadjuvant chemoradiotherapy (nCRT) is still controversial. The aim of this meta-analysis was to clarify the safety and feasibility of laparoscopic surgery compared with open resection.
Materials and Methods:
We performed a literature search for studies on PubMed, Embase and Cochrane Library up to March 1, 2018. Review Manager software was applied for data analysis. We used weighted mean difference (WMD) for continuous parameters and odds ratio (OR) for dichotomous variables. Confidence interval (CI) was set at 95% and a P value <.05 was considered statistically significant.
Results:
A total of seven studies met the inclusion criteria for the meta-analysis: 466 patients in laparoscopic group and 491 in open group. The pooled result revealed that laparoscopic resection had a favorable blood loss (WMD = −116.88 mL; 95% CI: −189.78 to −43.99; P = .002), analogous lymph nodes harvest (WMD = −0.30; 95% CI: −1.29 to 0.70; P = .56), less postoperative complications (OR = 0.63; 95% CI: 0.46–0.88; P = .006), shorter time to pass first flatus (WMD = −0.76 day; 95% CI: −1.00 to −0.51; P < .00001), and stay in hospital (WMD = −2.71 days; 95% CI: −4.54 to −0.88; P = .004), despite similar operating time (WMD = 11.17 minutes; 95% CI: −14.37 to 36.70; P = .39).
Conclusions:
Laparoscopic resection might be a technically safe and feasible approach for mid–low rectal cancer patients after nCRT compared with open resection.
Get full access to this article
View all access options for this article.
References
1.
TorreLA, BrayF, SiegelRL, et al.Global cancer statistics, 2012. CA Cancer J Clin, 2015; 65:87–108.
2.
SchmollHJ, Van CutsemE, SteinA, et al.ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol, 2012; 23:2479–2516.
3.
FujitaS, AkasuT, MizusawaJ, et al.Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): Results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol, 2012; 13:616–621.
4.
BaekJ, LeeG, LeeW. Comparison of long-term oncologic outcomes of stage III colorectal cancer following laparoscopic versus open surgery. Ann Surg Treat Res, 2015; 88:8.
5.
BonjerHJ, DeijenCL, AbisGA, et al.A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med, 2015; 372:1324–1332.
6.
JayneDG, ThorpeHC, CopelandJ, et al.Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg, 2010; 97:1638–1645.
7.
ZhaoD, LiY, WangS, HuangZ. Laparoscopic versus open surgery for rectal cancer: A meta-analysis of 3-year follow-up outcomes. Int J Colorectal Dis, 2016; 31:805–811.
8.
MougSJ, McCarthyK, Coode-BateJ, et al.Laparoscopic versus open surgery for colorectal cancer in the older person: A systematic review. Ann Med Surg, 2015; 4:311–318.
9.
BiondiA, GrossoG, MistrettaA, et al.Laparoscopic-assisted versus open surgery for colorectal cancer: short- and long-term outcomes comparison. J Laparoendosc Adv Surg Tech A, 2013; 23:1–7.
10.
WagmanR, MinskyBD, CohenAM, et al.Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: Long term follow-up. Int J Radiat Oncol Biol Phys, 1998; 42:51–57.
11.
Habr-GamaA, Gama-RodriguesJ, São JuliãoGP, et al.Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: Impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys, 2014; 88:822–828.
12.
IshiharaS, WatanabeT, FukushimaY, et al.Safety and factors contributing to the difficulty of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy. Tech Coloproctol, 2014; 18:247–255.
13.
HigginsJP, GreenS. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Cochrane Collaboration. 2011. http://handbook-5-1.cochrane.org. (accessed March20, 2011).
14.
StangA. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010; 25:603–605.
15.
HozoSP, DjulbegovicB, HozoI. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005; 5:13.
16.
ChenW, LiQ, QiuP, et al.Comparison of perioperative outcomes between laparoscopic and open surgery for mid-low rectal cancer with total mesorectal excision following neoadjuvant chemoradiotherapy. J Cancer Res Therapeut, 2016; 12:199.
17.
GeL, LeiC, HeD, et al.Evaluation of the efficacy of laparoscopic surgery in treatment of advanced mid-low rectal cancer following a long-term neoadjuvant chemoradiotherapy. Zhonghua Yi Xue Za Zhi, 2016; 96:2709–2712.
18.
HotchiM, ShimadaM, KuritaN, et al.Short-term results of laparoscopic surgery after preoperative chemoradiation for clinically staged T3 and T4 rectal cancer. Asian J Endosc Surg, 2012; 5:157–163.
19.
HuJ, LiangJ, WangZ, et al.Short-term outcomes of laparoscopically assisted surgery for rectal cancer following neoadjuvant chemoradiotherapy: A single-center experience. J Surg Res, 2014; 187:438–444.
20.
JeongS, ParkJW, NamBH, 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. Lancet Oncol, 2014; 15:767–774.
21.
KusanoT, InomataM, HiratsukaT, et al.A comparison of laparoscopic and open surgery following pre-operative chemoradiation therapy for locally advanced lower rectal cancer. Jpn J Clin Oncol, 2014; 44:305–310.
22.
SeshadriRA, SwaminathanR, SrinivasanA. Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: Long-term outcomes of a propensity score matched study. J Surg Oncol, 2018; 117:506–513.
23.
FerlayJ, ShinH, BrayF, et al.Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 2010; 127:2893–2917.
24.
SauerR, BeckerH, HohenbergerW, et al.Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med, 2004; 351:1731–1740.
25.
KennedyE, VellaET, Blair MacdonaldD, et al.Optimisation of preoperative assessment in patients diagnosed with rectal cancer. Clin Oncol, 2015; 27:225–245.
26.
AhnBH, LeeKH, ParkJB, et al.Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer. J Korean Surg Soc, 2012; 83:281.
27.
BuunenM, VeldkampR, HopWC, et al.Survival after laparoscopic surgery versus open surgery for colon cancer: Long-term outcome of a randomised clinical trial. Lancet Oncol, 2009; 10:44–52.
28.
KuhryE, SchwenkW, GaupsetR, et al.Long-term outcome of laparoscopic surgery for colorectal cancer: A cochrane systematic review of randomised controlled trials. Cancer Treat Rev, 2008; 34:498–504.
29.
WijesuriyaRE, DeenKI, HewavisenthiJ, et al.Neoadjuvant therapy for rectal cancer down-stages the tumor but reduces lymph node harvest significantly. Surg Today, 2005; 35:442–445.
30.
Camilleri-BrennanJ, SteeleRJ. Objective assessment of morbidity and quality of life after surgery for low rectal cancer. Colorectal Dis, 2002; 4:61–66.
31.
MarinatouA, TheodoropoulosGE, KaranikaS, et al.Do anastomotic leaks impair postoperative health-related quality of life after rectal cancer surgery? A case-matched Study. Dis Colon Rectum, 2014; 57:158–166.
