title: Systematic review of oncological outcomes following laparoscopic vs open total mesorectal excision.
abstract: OBJECTIVE
  To systematically analyze the randomized trials comparing the oncological and clinical effectiveness of laparoscopic total mesorectal excision (LTME) vs open total mesorectal excision (OTME) in the management of rectal cancer.
  
  
  METHODS
  Published randomized, controlled trials comparing the oncological and clinical effectiveness of LTME vs OTME in the management of rectal cancer were retrieved from the standard electronic medical databases. The data of included randomized, controlled trials was extracted and then analyzed according to the principles of meta-analysis using RevMan(®) statistical software. The combined outcome of the binary variables was expressed as odds ratio (OR) and the combined outcome of the continuous variables was presented in the form of standardized mean difference (SMD).
  
  
  RESULTS
  Data from eleven randomized, controlled trials on 2143 patients were retrieved from the electronic databases. There was a trend towards the higher risk of surgical site infection (OR = 0.66; 95%CI: 0.44-1.00; z = 1.94; P < 0.05), higher risk of incomplete total mesorectal resection (OR = 0.62; 95%CI: 0.43-0.91; z = 2.49; P < 0.01) and prolonged length of hospital stay (SMD, -1.59; 95%CI: -0.86--0.25; z = 4.22; P < 0.00001) following OTME. However, the oncological outcomes like number of harvested lymph nodes, tumour recurrence and risk of positive resection margins were statistically similar in both groups. In addition, the clinical outcomes such as operative complications, anastomotic leak and all-cause mortality were comparable between both approaches of mesorectal excision.
  
  
  CONCLUSIONS
  LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary rectal cancer in both short term and long term follow ups.
authors.affiliation: Muhammad Shafique Sajid, Adil Ahamd, William FA Miles, Mirza Khurrum Baig, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH United Kingdom.
authors.forename: Muhammad Shafique
authors.initials: MS
authors.lastname: Sajid
authors.affiliation: Muhammad Shafique Sajid, Adil Ahamd, William FA Miles, Mirza Khurrum Baig, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH United Kingdom.
authors.forename: Adil
authors.initials: A
authors.lastname: Ahamd
authors.affiliation: Muhammad Shafique Sajid, Adil Ahamd, William FA Miles, Mirza Khurrum Baig, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH United Kingdom.
authors.forename: William Fa
authors.initials: WF
authors.lastname: Miles
authors.affiliation: Muhammad Shafique Sajid, Adil Ahamd, William FA Miles, Mirza Khurrum Baig, Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH United Kingdom.
authors.forename: Mirza Khurrum
authors.initials: MK
authors.lastname: Baig
keywords: Abdominoperineal resection; Anterior resection; Oncological outcomes; Rectal cancer; Total mesorectal excision