The Impact of Minimally Invasive Surgery on the Incidence of Adhesive Small Bowel Obstruction and Related Complications Following Colorectal Cancer Resections: A Systematic Review and Meta-Analysis

Abstract

Background

Colorectal cancer is the third most common malignancy in the U.S., frequently managed with surgical resection. Adhesion-related complications, specifically small bowel obstruction (SBO), are frequent postoperative issues. This study examines whether minimally invasive surgery (MIS) reduces the risk of adhesive SBO compared to open surgery.

Methods

The PubMed, EMBASE/MEDLINE, and Cochrane databases were queried to identify studies comparing open vs MIS colorectal cancer resection. The primary endpoints were the incidence of adhesive SBO, SBO requiring surgery, parastomal hernia, and incisional hernia rate.

Results

Ten studies met inclusion criteria, comprising six randomized controlled studies (RCTs) and four non-RCTs, with a total of 23 032 patients—36.5% in the MIS group and 63.5% in the open group. Pooled analysis revealed a significantly lower incidence of adhesive SBO (RR: 0.58; CI: 0.45-0.75; P < .0001), SBO requiring surgery (RR: 0.69; CI: 0.49-0.96; P = .03), and infection rate (RR: 0.67; CI: 0.55-0.82; P < .0001) in the MIS group. No difference was seen in SBO requiring admission, incisional hernia (IH), IH requiring surgery, or length of hospital stay (LOS). The open group had a lower incidence of parastomal hernias (RR: 2.06; CI: 1.31-3.25; P = .002). Sensitivity analysis by using leave-one-out analysis also showed a significant reduction of adhesive SBO in the MIS group.

Conclusions

This study found reduced incidence of SBO, the need for SBO surgery, and infection rate with MIS surgery in colorectal cancer patients.