title: Medial versus lateral approach in laparoscopic colorectal resection: a systematic review and meta-analysis.
abstract: BACKGROUND
  The aim of this study was to investigate the safety and efficacy of the medial approach (MA) and the lateral approach (LA) in the treatment of colorectal disease.
  
  
  METHODS
  Studies published since 1994 that compared MA versus LA in laparoscopic colorectal resection were collected. Data on conversion rate, operative time, blood loss, number of harvested lymph nodes, hospital stay, complications, mortality, rate of recurrence, and hospitalization costs for MA and LA were meta-analyzed using fixed-effect and random-effect models.
  
  
  RESULTS
  Five cohort studies (2 randomized controlled trials and 3 retrospective studies) that included 881 patients were studied. Of these patients, 475 and 582 had undergone laparoscopic colorectal resection via MA and LA, respectively. There were significant reductions in conversion rate and operative time and possible reductions in blood loss and hospitalization costs for MA compared to LA; however, there were fewer harvested lymph nodes for MA compared with LA, which remains to be further studied. Other outcome variables such as postoperative complications, postoperative immune function, mortality, and rate of recurrence were not found to be statistically significant for either group. Sensitivity analysis on the pooled data from randomized controlled trials showed that the conversion rates were not significantly different between MA and LA.
  
  
  CONCLUSIONS
  Compared with the lateral approach, the medial approach has the advantages of shorter operative time and possibly lower conversion rate; it also can be as safe as the lateral approach. Whether the MA has less blood loss and lower hospitalization costs remains to be confirmed, and its oncological safety and long-term prognosis are not clear. Due to insufficient data from a limited number of studies, inadequate assessment of the results may arise.
authors.affiliation: Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang, China. dingjieboy@126.com
authors.forename: Jie
authors.initials: J
authors.lastname: Ding
authors.forename: Guo-qing
authors.initials: GQ
authors.lastname: Liao
authors.forename: Yu
authors.initials: Y
authors.lastname: Xia
authors.forename: Zhong-min
authors.initials: ZM
authors.lastname: Zhang
authors.forename: Yang
authors.initials: Y
authors.lastname: Pan
authors.forename: Sheng
authors.initials: S
authors.lastname: Liu
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhong-shu
authors.initials: ZS
authors.lastname: Yan
mesh_terms: D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D015233:Models, Statistical; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome