Martinez-Perez A, et al. - This meta-analysis was performed to review evidence on the short-term clinical outcomes of laparoscopic (LRR) vs open rectal resection (ORR) in patients with rectal cancer. Compared to ORR, LRR was correlated with lesser blood loss, smaller incision length, and longer operative times. For postoperative morbidity and mortality, no differences were observed.

Methods

• The researchers performed a systematic literature search using Cochrane Central Register, MEDLINE, EMBASE, Scopus, OpenGrey and ClinicalTrials.gov register for randomized clinical trials (RCTs) comparing LRR vs ORR for rectal cancer and reporting short-term clinical outcomes.
• They retrieved and reviewed articles published in English from January 1, 1995 to June 30, 2016.
• They followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statements checklist for reporting a systematic review.
• To estimate mean differences and risk ratios, random-effect models were used.
• They explored the robustness and heterogeneity of the results by performing sensitivity analyses.
• When P < 0.05, the pooled effect was considered significant.

Results

• The researchers included 14 RCTs.
• They found no differences in postoperative mortality (P=0.19) and morbidity (P=0.75) rates.
• For LRR, the mean operative time was 36.67 min longer (95%CI: 27.22-46.11, P < 0.00001), the mean estimated blood loss was 88.80 ml lower (95%CI: -117.25 to -60.34, P < 0.00001), and the mean incision length was 11.17 cm smaller (95%CI: -13.88 to -8.47, P < 0.00001) than ORR.
• The sensitivity analysis that focused on the 4 major RCTs confirmed these results.
• The mean length of hospital stay for LRR was 1.71 d shorter (95%CI: -2.84 to -0.58, P < 0.003) compared to ORR.
• Likewise, for LRR, bowel recovery (ie, day of the first bowel movement) was 0.68 d shorter (95%CI: -1.00 to -0.36, P < 0.00001).
• For these latter two parameters, the sensitivity analysis did not confirm a significant difference between LRR and ORR.
• In this study, the overall quality of the evidence was rated as high.