title: Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes.
abstract: BACKGROUND
  Whether laparoscopic-assisted surgery (LS) can achieve the same oncologic outcomes compared with open surgery (OS) for rectal cancer remains controversial. The aim of this meta-analysis of randomized controlled trials (RCTs) is to compare oncologic adequacy of resection and long-term oncologic outcomes of LS with OS in the treatment of rectal cancer.
  
  
  METHODS
  Literature searches of electronic databases (Pubmed, Embase, Web of Science, and Cochrane Library) and manual searches were performed to identify RCTs comparing values of oncologic adequacy of resection, recurrence, and survival following LS and OS.
  
  
  RESULTS
  Six RCTs enrolling 1,033 participants were included in the meta-analysis. LS was associated with similar number of lymph nodes harvested and a similar distal tumor-free margin. LS was associated with a slightly high circumferential resection margin (CRM) positive rate with no significant difference (7.94% vs. 5.37%; risk ratio [RR], 1.13; P = 0.63). There was no significant difference between the two groups in local recurrence (RR, 0.55; P = 0.21). The 3-year overall survival advantage for LS over OS was not statistically significantly different (hazard ratio [HR], 0.76; P = 0.11). The 3-year disease-free survival was not significantly different between the two groups (HR, 1.16; P = 0.64).
  
  
  CONCLUSIONS
  The meta-analysis suggests that there are no differences between laparoscopic-assisted and open surgery in terms of number of lymph nodes harvested, involvement of CRM, local recurrence, 3-year overall survival, and disease-free survival for rectal cancer. However, more high-quality studies are needed for further analysis due to the small number of included studies.
authors.affiliation: Department of Colorectal Surgery, The Sixth Affiliated Hospital (Guangdong Gastrointestinal Hospital), Sun Yat-sen University, Guangzhou 510655, People's Republic of China.
authors.forename: Mei-Jin
authors.initials: MJ
authors.lastname: Huang
authors.forename: Jing-Lin
authors.initials: JL
authors.lastname: Liang
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Liang
authors.initials: L
authors.lastname: Kang
authors.forename: Yan-Hong
authors.initials: YH
authors.lastname: Deng
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Wang
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome