title: Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis.
abstract: BACKGROUND
  Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer.
  
  
  METHODS
  A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the I (2) test and subgroup analysis on surgical and medical complications.
  
  
  RESULTS
  Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21-0.99, p = 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76-0.91, p < 0.001).
  
  
  CONCLUSIONS
  On the basis of evidence of both randomized and prospective controlled series, mortality and morbidity RR, including subgroup analysis, were significantly lower after laparoscopic compared to open surgery.
authors.affiliation: Department of Surgical Sciences, University of Turin, Turin, Italy. alberto.arezzo@mac.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.forename: Gitana
authors.initials: G
authors.lastname: Scozzari
authors.forename: Mauro
authors.initials: M
authors.lastname: Verra
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D018849:Controlled Clinical Trials as Topic / Q000706:statistics & numerical data; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008962:Models, Theoretical; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011184:Postoperative Period; D011446:Prospective Studies; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012306:Risk; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome