Evidence based medicine and surgical approaches for colon cancer: evidences, benefits and limitations of the laparoscopic vs open resection.
OBJECTIVE
To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection.


METHODS
Forty-seven manuscripts were reviewed, 33 of which employed for meta-analysis according to the PRISMA guidelines. The results were differentiated according to the study design (prospective randomized trials vs case-control series) and according to the tumor's location. Outcome measures included: (1) short-term results (operating times, blood losses, bowel function recovery, post-operative pain, return to the oral intake, complications and hospital stay); (2) oncological adequateness (number of nodes harvested in the surgical specimens); and (3) long-term results (including the survivals' rates and incidence of incisional hernias) and (4) costs.


RESULTS
Meta-analysis of trials provided evidences in support of the laparoscopic procedures for a several short-term outcomes including: a lower blood loss, an earlier recovery of the bowel function, an earlier return to the oral intake, a shorter hospital stay and a lower morbidity rate. Opposite the operating time has been confirmed shorter in open surgery. The same trend has been reported investigating case-control series and cancer by sites, even though there are some concerns regarding the power of the studies in this latter field due to the small number of trials and the small sample of patients enrolled. The two approaches were comparable regarding the mean number of nodes harvested and long-term results, even though these variables were documented reviewing the literature but were not computable for meta-analysis. The analysis of the costs documented lower costs for the open surgery, however just few studies investigated the incidence of post-operative hernias.


CONCLUSIONS
Laparoscopy is superior for the majority of short-term results. Future studies should better differentiate these approaches on the basis of tumors' location and the post-operative hernias.
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri, Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "La Sapienza", 00189 Rome, Italy.
Laura
L
Lorenzon
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri, Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "La Sapienza", 00189 Rome, Italy.
Marco
M
La Torre
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri, Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "La Sapienza", 00189 Rome, Italy.
Vincenzo
V
Ziparo
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri, Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "La Sapienza", 00189 Rome, Italy.
Francesco
F
Montebelli
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri, Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "La Sapienza", 00189 Rome, Italy.
Paolo
P
Mercantini
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri, Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "La Sapienza", 00189 Rome, Italy.
Genoveffa
G
Balducci
Laura Lorenzon, Marco La Torre, Vincenzo Ziparo, Francesco Montebelli, Paolo Mercantini, Genoveffa Balducci, Mario Ferri, Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "La Sapienza", 00189 Rome, Italy.
Mario
M
Ferri
D016063:Blood Loss, Surgical; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery* / Q000628:therapy*; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006547:Hernia / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery; D011184:Postoperative Period; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013514:Surgical Procedures, Operative; D015996:Survival Rate; D016896:Treatment Outcome
Colon cancer; Colon resection; Evidence-based medicine; Laparoscopy; Meta-analysis