Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis
Background Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer. Methods A systematic review fro...
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| Veröffentlicht in: | Surgical endoscopy 2013-05, Vol.27 (5), p.1485-1502 |
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| creator | Arezzo, Alberto Passera, Roberto Scozzari, Gitana Verra, Mauro Morino, Mario |
| description | Background
Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer.
Methods
A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the
I
2
test and subgroup analysis on surgical and medical complications.
Results
Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21–0.99,
p
= 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76–0.91,
p
|
| doi_str_mv | 10.1007/s00464-012-2649-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1326730178</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1326730178</sourcerecordid><originalsourceid>FETCH-LOGICAL-c481t-2859cbb72bd59b2ebea858800ceb3fc891d58fd72bfe86e7df521ab4bfde30293</originalsourceid><addsrcrecordid>eNp1kUtv1DAUha0K1E4HfgAbZIkNG4MfycTpDlVAkUZiU9aWH9eQKo-pr0Ob_no8SlshJDa2j-93z7V8CHkj-AfBefMROa92FeNCMrmrWnZ_QjaiUkVJoV-QDW8VZ7JpqzNyjnjDC96K-pScSSW00o3YkIe9Pdg0oZ8OC41Togl8tj31dvRwVGH2gBR_TSmzDGmgQznZvssLtWM4KteFoi4Ki3OfkU6RWooLZhhs7ny5_93B3UpDtsyOtl-ww1fkZbQ9wuvHfUt-fPl8fXnF9t-_frv8tGe-0iIzqevWO9dIF-rWSXBgda015x6cil63ItQ6hlKPoHfQhFhLYV3lYgDFZau25P3qe0jT7QyYzdChh763I0wzGqHkrlFcNLqg7_5Bb6Y5lfeulFI1L8uWiJXy5eMwQTSH1A02LUZwcwzGrMGYEow5BmPuS8_bR-fZDRCeO56SKIBcASyl8Sekv0b_1_UPxoqb7w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1326335063</pqid></control><display><type>article</type><title>Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Arezzo, Alberto ; Passera, Roberto ; Scozzari, Gitana ; Verra, Mauro ; Morino, Mario</creator><creatorcontrib>Arezzo, Alberto ; Passera, Roberto ; Scozzari, Gitana ; Verra, Mauro ; Morino, Mario</creatorcontrib><description>Background
Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer.
Methods
A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the
I
2
test and subgroup analysis on surgical and medical complications.
Results
Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21–0.99,
p
= 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76–0.91,
p
< 0.001).
Conclusions
On the basis of evidence of both randomized and prospective controlled series, mortality and morbidity RR, including subgroup analysis, were significantly lower after laparoscopic compared to open surgery.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-012-2649-x</identifier><identifier>PMID: 23183871</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject><![CDATA[Abdominal Surgery ; Abscesses ; Anastomotic Leak - epidemiology ; Blood Loss, Surgical ; Blood Transfusion - utilization ; Carcinoma - mortality ; Carcinoma - surgery ; Colorectal cancer ; Controlled Clinical Trials as Topic - statistics & numerical data ; Endpoint Determination ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Laparoscopy ; Laparoscopy - adverse effects ; Laparoscopy - statistics & numerical data ; Laparotomy ; Laparotomy - statistics & numerical data ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Meta-analysis ; Models, Theoretical ; Morbidity ; Mortality ; Postoperative Complications - epidemiology ; Postoperative Complications - prevention & control ; Postoperative Period ; Proctology ; Prospective Studies ; Publication Bias ; Randomized Controlled Trials as Topic - statistics & numerical data ; Recovery of Function ; Rectal Neoplasms - mortality ; Rectal Neoplasms - surgery ; Review ; Risk ; Sensitivity and Specificity ; Surgery ; Surgical anastomosis ; Surgical outcomes ; Survival Analysis ; Systematic review ; Treatment Outcome]]></subject><ispartof>Surgical endoscopy, 2013-05, Vol.27 (5), p.1485-1502</ispartof><rights>Springer Science+Business Media New York 2012</rights><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-2859cbb72bd59b2ebea858800ceb3fc891d58fd72bfe86e7df521ab4bfde30293</citedby><cites>FETCH-LOGICAL-c481t-2859cbb72bd59b2ebea858800ceb3fc891d58fd72bfe86e7df521ab4bfde30293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-012-2649-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-012-2649-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23183871$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arezzo, Alberto</creatorcontrib><creatorcontrib>Passera, Roberto</creatorcontrib><creatorcontrib>Scozzari, Gitana</creatorcontrib><creatorcontrib>Verra, Mauro</creatorcontrib><creatorcontrib>Morino, Mario</creatorcontrib><title>Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer.
Methods
A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the
I
2
test and subgroup analysis on surgical and medical complications.
Results
Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21–0.99,
p
= 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76–0.91,
p
< 0.001).
Conclusions
On the basis of evidence of both randomized and prospective controlled series, mortality and morbidity RR, including subgroup analysis, were significantly lower after laparoscopic compared to open surgery.</description><subject>Abdominal Surgery</subject><subject>Abscesses</subject><subject>Anastomotic Leak - epidemiology</subject><subject>Blood Loss, Surgical</subject><subject>Blood Transfusion - utilization</subject><subject>Carcinoma - mortality</subject><subject>Carcinoma - surgery</subject><subject>Colorectal cancer</subject><subject>Controlled Clinical Trials as Topic - statistics & numerical data</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - adverse effects</subject><subject>Laparoscopy - statistics & numerical data</subject><subject>Laparotomy</subject><subject>Laparotomy - statistics & numerical data</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Models, Theoretical</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Postoperative Period</subject><subject>Proctology</subject><subject>Prospective Studies</subject><subject>Publication Bias</subject><subject>Randomized Controlled Trials as Topic - statistics & numerical data</subject><subject>Recovery of Function</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - surgery</subject><subject>Review</subject><subject>Risk</subject><subject>Sensitivity and Specificity</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><subject>Surgical outcomes</subject><subject>Survival Analysis</subject><subject>Systematic review</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kUtv1DAUha0K1E4HfgAbZIkNG4MfycTpDlVAkUZiU9aWH9eQKo-pr0Ob_no8SlshJDa2j-93z7V8CHkj-AfBefMROa92FeNCMrmrWnZ_QjaiUkVJoV-QDW8VZ7JpqzNyjnjDC96K-pScSSW00o3YkIe9Pdg0oZ8OC41Togl8tj31dvRwVGH2gBR_TSmzDGmgQznZvssLtWM4KteFoi4Ki3OfkU6RWooLZhhs7ny5_93B3UpDtsyOtl-ww1fkZbQ9wuvHfUt-fPl8fXnF9t-_frv8tGe-0iIzqevWO9dIF-rWSXBgda015x6cil63ItQ6hlKPoHfQhFhLYV3lYgDFZau25P3qe0jT7QyYzdChh763I0wzGqHkrlFcNLqg7_5Bb6Y5lfeulFI1L8uWiJXy5eMwQTSH1A02LUZwcwzGrMGYEow5BmPuS8_bR-fZDRCeO56SKIBcASyl8Sekv0b_1_UPxoqb7w</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Arezzo, Alberto</creator><creator>Passera, Roberto</creator><creator>Scozzari, Gitana</creator><creator>Verra, Mauro</creator><creator>Morino, Mario</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20130501</creationdate><title>Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis</title><author>Arezzo, Alberto ; Passera, Roberto ; Scozzari, Gitana ; Verra, Mauro ; Morino, Mario</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-2859cbb72bd59b2ebea858800ceb3fc891d58fd72bfe86e7df521ab4bfde30293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdominal Surgery</topic><topic>Abscesses</topic><topic>Anastomotic Leak - epidemiology</topic><topic>Blood Loss, Surgical</topic><topic>Blood Transfusion - utilization</topic><topic>Carcinoma - mortality</topic><topic>Carcinoma - surgery</topic><topic>Colorectal cancer</topic><topic>Controlled Clinical Trials as Topic - statistics & numerical data</topic><topic>Endpoint Determination</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - adverse effects</topic><topic>Laparoscopy - statistics & numerical data</topic><topic>Laparotomy</topic><topic>Laparotomy - statistics & numerical data</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Models, Theoretical</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Postoperative Period</topic><topic>Proctology</topic><topic>Prospective Studies</topic><topic>Publication Bias</topic><topic>Randomized Controlled Trials as Topic - statistics & numerical data</topic><topic>Recovery of Function</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - surgery</topic><topic>Review</topic><topic>Risk</topic><topic>Sensitivity and Specificity</topic><topic>Surgery</topic><topic>Surgical anastomosis</topic><topic>Surgical outcomes</topic><topic>Survival Analysis</topic><topic>Systematic review</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arezzo, Alberto</creatorcontrib><creatorcontrib>Passera, Roberto</creatorcontrib><creatorcontrib>Scozzari, Gitana</creatorcontrib><creatorcontrib>Verra, Mauro</creatorcontrib><creatorcontrib>Morino, Mario</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arezzo, Alberto</au><au>Passera, Roberto</au><au>Scozzari, Gitana</au><au>Verra, Mauro</au><au>Morino, Mario</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>27</volume><issue>5</issue><spage>1485</spage><epage>1502</epage><pages>1485-1502</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer.
Methods
A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the
I
2
test and subgroup analysis on surgical and medical complications.
Results
Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21–0.99,
p
= 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76–0.91,
p
< 0.001).
Conclusions
On the basis of evidence of both randomized and prospective controlled series, mortality and morbidity RR, including subgroup analysis, were significantly lower after laparoscopic compared to open surgery.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>23183871</pmid><doi>10.1007/s00464-012-2649-x</doi><tpages>18</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Abscesses Anastomotic Leak - epidemiology Blood Loss, Surgical Blood Transfusion - utilization Carcinoma - mortality Carcinoma - surgery Colorectal cancer Controlled Clinical Trials as Topic - statistics & numerical data Endpoint Determination Female Gastroenterology Gynecology Hepatology Humans Laparoscopy Laparoscopy - adverse effects Laparoscopy - statistics & numerical data Laparotomy Laparotomy - statistics & numerical data Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Meta-analysis Models, Theoretical Morbidity Mortality Postoperative Complications - epidemiology Postoperative Complications - prevention & control Postoperative Period Proctology Prospective Studies Publication Bias Randomized Controlled Trials as Topic - statistics & numerical data Recovery of Function Rectal Neoplasms - mortality Rectal Neoplasms - surgery Review Risk Sensitivity and Specificity Surgery Surgical anastomosis Surgical outcomes Survival Analysis Systematic review Treatment Outcome |
| title | Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis |
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