Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme

Abstract

Fast track surgery accelerates recovery, reduces morbidity and shortens hospital stay. It is unclear what the effects are of laparoscopic or open surgery within a fast track programme. The aim of this systematic review was to review the existing evidence. A systematic review was performed of all randomized (RCTs) and controlled clinical trials (CCTs) on laparoscopic and open surgery within a fast track setting. Primary endpoints were primary and overall hospital stay, readmission rate, morbidity and mortality. Study selection, quality assessment and data extraction were performed independently by two observers. Only two RCTs and three CCTs were eligible for final analysis, which reported on 400 patients. Data could not be pooled because of clinical heterogeneity. One RCT and one CCT stated a shorter primary hospital stay in the laparoscopic group of 3 and 2 days, respectively. In one RCT, the readmission rate was lower in the laparoscopic group; absolute risk reduction (ARR) 21.4% [95% confidence interval (CI): 6-42.3%] resulting in a number needed to treat (NNT) of 4.7 patients (95% CI: 2.4-176). Another study showed a 23% difference in favour of the laparoscopic group with regard to morbidity (95% CI: 6.3-39.1%), i.e. an NNT of 4.4 patients (95% CI: 2.6-15.9). There were no significant differences in mortality rates. Due to the present lack of data, no robust conclusions can be made. A large randomized controlled trial is required to compare laparoscopic with open surgery within a fast track setting.