Laparoscopic surgery for colorectal cancer: safe and effective? - A systematic review.
OBJECTIVE
To determine the clinical effectiveness of laparoscopic and laparoscopically assisted surgery in comparison with open surgery for the treatment of colorectal cancer.


BACKGROUND
Open resection is the standard method for surgical removal of primary colorectal tumours. However, there is significant morbidity associated with this procedure. Laparoscopic resection (LR) is technically more difficult but may overcome problems associated with open resections (OR).


METHODS
Systematic review and meta-analysis of short- and long-term data from randomised controlled trials (RCTs) comparing LS with OR.


RESULTS
Highly sensitive searches of nine databases identified 19 primary RCTs describing data from over 4,500 participants. Length of hospital stay is shorter, blood loss and pain are less, and return to usual activities is likely to be faster after LR than after OR, but duration of operation is longer. Lymph node retrieval, completeness of resection and quality of life do not appear to differ. No statistically significant differences were observed in rates of anastomotic leakage, abdominal wound breakdown, incisional hernia, wound and urinary tract infections, operative and 30-day mortality, and recurrences, nor in overall and disease-free survival up to three years.


CONCLUSIONS
LR is associated with a quicker recovery in terms of return to usual activities and length of hospital stay with no evidence of a difference in complications or long-term outcomes in comparison to OR, up to three years postoperatively.
Lourenco
Tania
T
Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Health Sciences Building, 3rd Floor Foresterhill, Aberdeen, AB25 2ZD, United Kingdom. tania.lourenco@abdn.ac.uk
Murray
Alison
A
Grant
Adrian
A
McKinley
Aileen
A
Krukowski
Zygmunt
Z
Vale
Luke
L
D015179:Colorectal Neoplasms / Q000601:surgery*; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D007432:Intraoperative Period; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D007902:Length of Stay; D011183:Postoperative Complications; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome