title: Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  Laparoscopic and open rectal resection for cancer were compared by analysing a total of 26 end points which included intraoperative and postoperative recovery, short-term morbidity and mortality, late morbidity and long-term oncological outcomes.
  
  
  METHODS
  We searched for published randomized clinical trials, presenting a comparison between laparoscopic and open rectal resection for cancer using the following electronic databases: PubMed, OVID, Medline, Cochrane Database of Systematic Reviews, EBM Reviews, CINAHL and EMBASE.
  
  
  RESULTS
  Nine randomized clinical trials (RCTs) were included in the meta-analysis incorporating a total of 1544 patients, having laparoscopic (N = 841) and open rectal resection (N = 703) for cancer. Laparoscopic surgery for rectal cancer was associated with a statistically significant reduction in intraoperative blood loss and in the number of blood transfusions, earlier resuming solid diet, return of bowel function and a shorter duration of hospital stay. We also found a significant advantage for laparoscopy in the reduction of post-operative abdominal bleeding, late intestinal adhesion obstruction and late morbidity. No differences were found in terms of intra-operative and late oncological outcomes.
  
  
  CONCLUSIONS
  The meta-analysis indicates that laparoscopy benefits patients with shorter hospital stay, earlier return of bowel function, reduced blood loss and number of blood transfusions and lower rates of abdominal postoperative bleeding, late intestinal adhesion obstruction and other late morbidities.
authors.affiliation: Department of General Surgery, S Maria Hospital, University of Perugia, Terni, Italy. stefano.trastulli@hotmail.it
authors.forename: S
authors.initials: S
authors.lastname: Trastulli
authors.forename: R
authors.initials: R
authors.lastname: Cirocchi
authors.forename: C
authors.initials: C
authors.lastname: Listorti
authors.forename: D
authors.initials: D
authors.lastname: Cavaliere
authors.forename: N
authors.initials: N
authors.lastname: Avenia
authors.forename: N
authors.initials: N
authors.lastname: Gullà
authors.forename: G
authors.initials: G
authors.lastname: Giustozzi
authors.forename: F
authors.initials: F
authors.lastname: Sciannameo
authors.forename: G
authors.initials: G
authors.lastname: Noya
authors.forename: C
authors.initials: C
authors.lastname: Boselli
mesh_terms: D000005:Abdomen / Q000601:surgery; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001810:Blood Volume; D003672:Defecation; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D010502:Perineum / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*