title: Laparoscopic versus open surgery for rectal cancer: A meta-analysis of classic randomized controlled trials and high-quality Nonrandomized Studies in the last 5 years.
abstract: OBJECTIVE
  To present a meta-analysis of high-quality published reports comparing laparoscopic rectal resection (LRR) and open rectal resection (ORR) for rectal cancer.
  
  
  METHODS
  Studies that compared LRR and ORR and were published within the last 5 years were identified. All eligible randomized controlled trials (RCTs) and non-randomized comparative trials (NRCTs) were evaluated based on the Jadad score, the Cochrane risk of bias assessment tool and modified Methodological Indices for Nonrandomized Studies (MINORS). The mean differences (MD) and odds ratios (OR) were used to compare the operative time, blood loss, mortality, complications, harvested lymph nodes, hospital stay, distal resection margin, and circumferential resection margin. The risk ratio (RR) method was used to examine recurrence and survival.
  
  
  RESULTS
  Fourteen studies were identified and included 7 RCTs and 7 NRCTs and 4353 patients (2251 LRR, 2102 ORR). Although the operation time of the LRR group was obviously longer than that of the conventional surgery group (MD = 25.64, 95%CI = [5.17,46.10], P = 0.01), LRR was associated with fewer overall complications (OR = 0.67, 95%CI = [0.52,0.87], P = 0.002), less blood loss (MD = -66.49, 95%CI = [-88.31, -44.66], P < 0.00001), shorter postoperative hospital stays (OR = -1.26,95%CI = [-2.45, -0.07],P = 0.004) and shorter bowel function recovery times (MD = -0.93, 95%CI = [-1.27,-0.58], P < 0.00001). Moreover, the difference in the DRM was statistically clear (MD = 0.14, 95%CI = [0.02,0.27], P = 0.03). However, no significant differences between the LRR and ORR groups were observed in terms of the number of lymph nodes harvested, mortality, positive CRM, local and distal recurrence, or overall and disease-free survival.
  
  
  CONCLUSIONS
  This study indicates that there are no significant differences between LRR and ORR in terms of survival and pathological outcomes with the exception of the DRM. Moreover, this study suggests that LRR can be performed safely and elicits faster recovery times compared with conventional surgery.
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
authors.forename: Ke
authors.initials: K
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Cao
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
authors.forename: Bo
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
authors.forename: Mingqing
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
authors.forename: Xingyu
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
authors.forename: Wenwen
authors.initials: W
authors.lastname: Cai
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
authors.forename: Yicheng
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China. Electronic address: xiongmd@aliyun.com.
authors.forename: Maoming
authors.initials: M
authors.lastname: Xiong
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology; D065228:Non-Randomized Controlled Trials as Topic; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Laparoscopic surgery; Meta-analysis; Open surgery; Rectal cancer