title: Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years?
abstract: OBJECTIVE
  Laparoscopic rectal cancer surgery has been increasingly used since 1991 following the publication of the first case series. Since then, several studies have confirmed that laparoscopic surgery for rectal cancer is challenging with associated morbidity and mortality. The aim of this study was to determine if the rates of early postoperative complications in laparoscopic rectal cancer surgery have improved over the past 20 years.
  
  
  METHODS
  A literature search of the EMBASE and MEDLINE databases between August 1991 and August 2011 was conducted using the keywords laparoscopy, rectal cancer and postoperative complications. Data were analysed using linear regression ANOVA performed in GNUMERICS software.
  
  
  RESULTS
  Ninety-seven studies were included for analysis. Over the last 20 years there has been no significant change in the rate of any early postoperative complications (anastomotic leak, conversion, sexual, urinary or faecal dysfunction, wound infection, overall morbidity or mortality). However, in the last 3 years, the rate of positive resection margins has decreased significantly (P = 0.01).
  
  
  CONCLUSIONS
  There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.
authors.affiliation: Laparoscopic Colorectal Surgery and Training Unit, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: R
authors.initials: R
authors.lastname: Shearer
authors.forename: M
authors.initials: M
authors.lastname: Gale
authors.forename: O E
authors.initials: OE
authors.lastname: Aly
authors.forename: E H
authors.initials: EH
authors.lastname: Aly
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical; D003672:Defecation; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D007902:Length of Stay; D018365:Neoplasm, Residual; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D014555:Urination Disorders / Q000209:etiology
keywords: Rectal surgery; complications; laparoscopic