Open versus laparoscopic colectomy for colorectal cancer: A meta-analysis
Manoj Pandey, Mridula Shukla and Rajesh K Singh
World journal of Minimal Access Surgery 2012, 1:3
Despite a decade experience of surgery by laparoscopy for colorectal cancer the safety and efficacy is still being debatable. We performed a meta-analysis of randomized controlled trials (RCTs), published between 1996 and July 2010 comparing laparoscopic vs open colonic resections for colorectal cancer.
A thorough search of the Medline, Embase and Cochrane library was made and identified RCTs were obtained and analysed for short-term and long-term outcome variables. For continuous data mean difference and inverse variance were used for calculating the odds ratio (OR). Z test was used to calculate the overall effect and heterogeneity was tested by Chi-square and I2 values.
A total of 43 studies were identified from 41 RCTs, not all variables were available in all studies, hence only those studies with particular variables were used for individual meta-analysis. A total of 35 studies evaluated 8940 participants with cumulative OR for operating time was 42 (95% CI 38.3 – 45.7); blood loss was evaluated in 19 studies with 5207 participants and an OR of 144.36 (95% CI 149.2-139.5) and 26 studies with 6460 participants reported on hospital stay with OR of 3.26 (95% CI 3.51 – 3.01) while lymph node yield was reported in 16 studies with 5515 participants and OR of 0.24 (0.82 – 0.34) respectively; all favoring laparoscopy. The meta analysis of present data suggest that laparoscopic resection of malignant esophageal or colonic carcinoma may be a better alternative as it has better short term outcome with no difference in survival at 5 years.
The results of present meta-analysis suggests that despite having a higher operating time, the blood loss and the hospital stay is significantly lower in laparoscopic group. The lymph node yield shows a trend favoring laparoscopy, however the effect is not significant. Laparoscopic colectomy appears to be a better method of surgery for colorectal cancer.