Laparoscopic Versus Conventional Open Surgery in Intersphincteric Resection for Low Rectal Cancer: A Systematic Review and Meta-Analysis

Background and Aims: The intersphincteric resection (ISR) is beneficial for saving patients' anus to a large extent and restoring original bowel continuity. Laparoscopic ISR (L-ISR) has its drawbacks, such as two-dimensional images, low motion flexibility, and unstable lens. Recently, da Vinci robotic ISR (R-ISR) is increasingly used worldwide. The purpose of this article is to compare the feasibility, safety, oncological outcomes, and clinical efficacy of R-ISR vs. L-ISR for low rectal cancer.Methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched to identify comparative studies of R-ISR vs. L-ISR. Demographic, clinical, and outcome data were extracted. Mean difference (MD) and risk ratio (RR) with their corresponding confidence intervals (CIs) were calculated.Results: Five studies were included. In total, 510 patients were included, of whom 273 underwent R-ISR and 237 L-ISR. Compared with L-ISR, R-ISR has significantly lower estimated intraoperative blood loss (MD = −23.31, 95% CI [−41.98, −4.64], P = 0.01), longer operative time (MD = 51.77, 95% CI [25.68, 77.86], P = 0.0001), hospitalization days (MD = −1.52, 95% CI [−2.10, 0.94], P < 0.00001), and postoperative urinary complications (RR = 0.36, 95% CI [0.16, 0.82], P = 0.02).Conclusions: The potential benefits of R-ISR are considered as a safe and feasible alternative choice for the treatment of low rectal tumors.

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Laparoscopic versus Open Surgery in Lateral Lymph Node Dissection for Advanced Rectal Cancer: A Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2019/7689082 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 7

Author(s):

Manzhao Ouyang ◽

Tianyou Liao ◽

Yan Lu ◽

Leilei Deng ◽

Zhentao Luo ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Open Surgery ◽

Meta Analysis ◽

Advanced Rectal Cancer ◽

R0 Resection ◽

Resection Rate ◽

Lateral Lymph Node ◽

Oncological Outcomes ◽

Conventional Open Surgery

Aim. To compare the clinical efficacies between laparoscopic and conventional open surgery in lateral lymph node dissection (LLND) for advanced rectal cancer. Methods. We comprehensively searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data and performed a cumulative meta-analysis. According to inclusion criteria and exclusion criteria, all eligible randomized controlled trials (RCTs) or retrospective or prospective comparative studies assessing the two techniques were included, and then a meta-analysis was performed by using RevMan 5.3 software to assess the difference in clinical and oncological outcomes between the two treatment approaches. Results. Eight studies involving a total of 892 patients were finally selected, with 394 cases in the laparoscopic surgery group and 498 cases in the traditional open surgery group. Compared with the traditional open group, the laparoscopic group had a longer operative time (WMD=81.56, 95% CI (2.09, 142.03), P=0.008), but less intraoperative blood loss (WMD=−452.18, 95% CI (-652.23, -252.13), P<0.00001), shorter postoperative hospital stay (WMD=−5.30, 95% CI (-8.42, -2.18), P=0.0009), and higher R0 resection rate (OR=2.17, 95% CI (1.14, 4.15), P=0.02). There was no significant difference in the incidence of surgical complications between the two groups (OR=0.52, 95% CI (0.26, 1.07), P=0.08). Lateral lymph node harvest, lateral lymph node metastasis, local recurrence, 3-year overall survival, and 3-year disease-free survival did not differ significantly between the two approaches (P>0.05). Conclusion. Laparoscopic LLND has a similar efficacy in oncological outcomes and postoperative complications to the conventional open surgery, with the advantages of reduced intraoperative blood loss, shorter postoperative hospital stay, and higher R0 resection rate, and tumor radical cure is similar to traditional open surgery. Laparoscopic LLND is a safe and feasible surgical approach, and it may be used as a standard procedure in LLND for advanced rectal cancer.

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Is the laparoscopic approach for rectal cancer superior to open surgery? A systematic review and meta-analysis on short-term surgical outcomes

Videosurgery and Other Miniinvasive Techniques ◽

10.5114/wiitm.2018.75845 ◽

2018 ◽

Vol 13 (2) ◽

pp. 129-140 ◽

Cited By ~ 5

Author(s):

Piotr Małczak ◽

Magdalena Mizera ◽

Grzegorz Torbicz ◽

Jan Witowski ◽

Piotr Major ◽

...

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Surgical Outcomes ◽

Open Surgery ◽

Meta Analysis ◽

Laparoscopic Approach ◽

Short Term

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Comparation of Laparoscopic Intersphincteric Resection and Abdominoperineal Resection for Ultra-Low Rectal Cancer Patients - a Retrospective Analysis, and a Meta-analysis of Oncology Outcome

10.21203/rs.3.rs-35748/v1 ◽

2020 ◽

Author(s):

Xianwei Mo ◽

Wentao Wang ◽

Haiquan Qin ◽

Hao Lai ◽

Zigao Huang ◽

...

Keyword(s):

Rectal Cancer ◽

Survival Rate ◽

Retrospective Analysis ◽

Cancer Patients ◽

Abdominoperineal Resection ◽

Meta Analysis ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Complication Rates ◽

Laparoscopic Intersphincteric Resection

Abstract Purpose The aim of the study is to evaluate the surgical and oncology outcomes between laparoscopic Intersphincteric Resection (LISR) and laparoscopic-assisted Abdominoperineal Resection (LARC) for ultra-low rectal cancer patients by using a retrospective analysis, and a meta-analysis of the literature was carried out to further validate the oncology outcome. Patients and methods: Between April 2014 and December 2015, a total of 38 rectal cancer patients who underwent LISR and 41 LARC patients were enrolled in this study. The comparison between the groups was based on clinicopathological characteristics and surgical outcomes. Meta-analysis of published studies, exploring oncology outcome of between LISR and LARC, was carried out using STATA 12.0 software. Results Operating time, blood loss, length of hospital stay, and postoperative complication rates was similar between LISR group and LARC group; Patients undergoing LISR also had a similarly 5-year local recurrence and overall survival rate with LAPR. Meta-analysis showed that five studies, which included a total of 791 patients were final involved for this analysis. Comparing APR, ISR patients obtain similarly 5-years recurrence rate and 5-years survival rate. Conclusion This study suggests that LISR is as technically feasible, safe, and effective as LARC for treating patients with low rectal cancer. Additional high-powered randomized trials are needed to determine whether LISR truly offers any advantages.

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