The meta analysis of pathological and long-term outcomes of laparoscopic vs. open surgery for rectal cancer.

Abstract

e15039 Background: The non-inferiority of laparoscopic surgery (LS) for rectal cancer remains controversial. This study aimed to compare pathological and long-term outcomes of LS and open surgery (OS). Methods: We searched eligible randomized clinical trials (RCTs), published between Jan 1990 and Nov 2015, to compare LS and OS for rectal cancer. For dichotomous and continuous variables, the outcomes were summarized as odds ratios (ORs) and weighted mean differences (WMDs) respectively. The combined survival outcomes were expressed as hazard ratios (HRs). Subgroup analysis was conducted for patients underwent total mesorectal excision (TME). The PRISMA statement was complied. Results: Fifteen RCTs enrolling 4112 patients were included. The patients’ baseline characteristics of two groups were similar. The incomplete resection of mesorectal fascia was significantly more common in LS patients (OR, 1.49). There were no significant differences in circumferential resection margin (CRM) involvement, number of lymph nodes harvested, distal resection margin clearance. The TME subgroup analysis showed a higher rate of CRM involvement in LS group (OR, 1.56). The disease free survival and overall survival were equivalent. The inferior pathological results were led by the latest trials of ALaCaRT and ACOSOGZ6051, which had not reported the long-term results. Conclusions: This study demonstrated that laparoscopic rectal cancer resection related with the inferiority for pathological outcomes, especially in patients received TME. More long-term results of RCTs are mandatory to evaluate the safety of LS for rectal cancer. Meta-analysis results of pathological and long-term outcomes. Outcomes Overall Analysis Subgroup Analysis (TME) Number (LS/OS) OR, WMD or HR (95% CI) P Number (LS/OS) OR, WMD or HR (95% CI) P Incomplete Mesorectal Fascia 1348/989 1.49 (1.17,1.90) 0.001 682/ 658 1.52 (1.14,2.03) 0.004 CRM Involvement 1780/ 1377 1.22 (0.92,1.61) 0.17 840/ 818 1.56 (1.03,2.38) 0.04 Disease Free Survival 1348/880 0.94 (0.83,1.08) 0.39 343/ 338 0.97 (0.79,1.19) 0.78 Overall Survival 1517/ 1054 0.90 (0.80,1.02) 0.11 512/ 512 0.99 (0.84,1.16) 0.89 I 2 value of above outcomes were 0 % indicating no heterogeneity.