title: Efficacy and safety of laparo-endoscopic resections of colorectal neoplasia: A systematic review.
abstract: OBJECTIVE
  The purpose of this review is to assess the efficacy and safety of laparo-endoscopic local resections for colorectal lesions not suitable for endoscopic resection.
  
  
  BACKGROUND
  The combined laparo-endoscopic approach has been proposed for large colorectal lesions unsuitable for endoscopic resection, in order to reduce morbidity of common laparoscopic resection. However, data on the efficacy and safety of laparo-endoscopic local resections are still controversial.
  
  
  METHODS
  An Embase search of papers published during the period 1985-2014 was performed. Published studies that evaluated laparo-endoscopic resections for colorectal lesions were assessed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) recommendations by two authors. Forest plots on primary (per-lesion rate of further surgery, including surgery for complications and surgery for oncologic radical treatment) and secondary outcomes were produced based on fixed and random effects models. Heterogeneity was assessed using the I (2) statistic. Risk for within-study bias was ascertained with QUADAS (Quality Assessment of Diagnostic Accuracy Studies) system.
  
  
  RESULTS
  A total of 11 studies provided data on 707 lesions treated with a combined laparo-endoscopic approach. A variety of techniques were reported. The overall per-lesion rate of further surgery was 9.5%, while per-lesion rate of further surgery for oncologic treatment was 7.9%, per-lesion rate of further surgery for complications treatment was 3.5%, incidence of adenocarcinoma was 10.5%, incidence of overall complications was 7.9%, incidence of conversion to open surgery 4.3% and incidence of recurrence was 5.4%.
  
  
  CONCLUSIONS
  Despite laparo-endoscopic approach ensures limited invasiveness, it is affected by a consistent rate of complications and oncologic inadequacy that often requires further surgical treatment.
authors.affiliation: Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.affiliation: Department of Medical Sciences, University of Torino, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.affiliation: Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Migliore
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Terni, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Department of Clinical Medicine and Surgery, University Federico II of Napoli, Napoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galloro
authors.affiliation: Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manta
authors.affiliation: Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
keywords: Polypectomy; colectomy; colo-rectal neoplasia; laparo-endoscopic resections; systematic review