Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials.
BACKGROUND
The aim of this systematic review is to evaluate long-term outcome of laparoscopically assisted versus open surgery for non-metastasised colorectal cancer.


METHODS
Cochrane library, EMBASE, Pub med and CancerLit were searched for published and unpublished randomised controlled trials. RevMan 4.2 was used for statistical analysis.


RESULTS
Twelve trials (3346 patients) reported long-term outcome and were included in the current analyses. No significant differences were found between laparoscopic and open surgery in the occurrence of incisional hernias or the number of reoperations for adhesions (p=0.32 and 0.30, respectively). Port-site metastases and wound recurrences were rare and no differences in occurrence after laparoscopic and open surgery were observed (p=0.16). Cancer-related mortality at maximum follow-up was similar after laparoscopic and open surgery (p=0.15 and 0.16 for colon and rectal cancer, respectively). No significant difference in tumour recurrence after laparoscopic and open surgery for colon cancer was observed (3 RCTs, hazard ratio for tumour recurrence in the laparoscopic group 0.86; 95% CI 0.70-1.08). In colon cancer patients, no significant differences in overall mortality were found (2 RCTs, hazard ratio for overall mortality after laparoscopic surgery 0.86; 95% CI 0.86-1.07).


CONCLUSIONS
Laparoscopic resection of carcinoma of the colon is associated with a long-term outcome that is similar to that after open colectomy. Laparoscopic surgery for cancer of the upper rectum is feasible, but more randomised trials need to be conducted to assess long-term outcome.
Kuhry
Esther
E
Department of Surgery, Nord-Trøndelag Health Trust, Namsos Hospital, Sykehusalleen 1, 7809 Namos, Norway. esther.kuhry@gmail.com
Schwenk
Wolfgang
W
Gaupset
Robin
R
Romild
Ulla
U
Bonjer
Jaap
J
D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000209:etiology / Q000601:surgery; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D009364:Neoplasm Recurrence, Local; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome