Laparoscopic Versus Open Surgery For Colorectal Cancer: A Meta Analysis

Objective To compare clinical outcomes and safety of laparoscopic surgery (LS) with those of open surgery (OS) for colorectal cancer.Methods Literature search were performed by key words, such as colorectal cancer, laparoscopy on all randomized controlled trails reported on laparoscopic versus open surgery for colorectal cancer between January 1991 and July 2007. Two authors drew the details of trail design, characteristics of patients, outcomes and so on from the studies included. Date analysis was performed by RevMan 4.2.Results According to the same screening criteria, 26 clinical studies were included in this meta-analysis. Sample volume in this meta-analysis was 6910 colorectal cancer cases. The baseline characteristics of LS group were similar to those of OS group. In comparison with OS group, the length of incision of LS group was shorter by 10.29cm,[95%CI(-13.27,-7.32), p<0.00001], blood loss was less by 88.25 ml, [95%CI(-139.03,-21.45), p=0.0007], however , the operation time was longer by 41.19min, [95%CI(36.54,45.84), p<0.00001]. There were no significant differences in the length of resected specimen, number of retrieved lymph nodes, and overall morbidity rate of intra-operation complications. The morbidity rate of the postoperative complications is decreased in the LS group. The average time before the postoperative first flatus, first bowel movement and liquid diet resumption, and discharge were shorter by 1.02 days, [95%CI (-1.34, -0.77), p<0.00001] , 1.05days, [95%CI (-1.51, -0.56), p<0.00001] and 1.27days,[95%CI (-1.46, -1.08), p<0.00001], 2.21days [95%CI (-3.22, -1.20), p<0.00001], respectively. There were no significant differences in 5-year overall survival, 5-year disease-free survival, the incidence of local recurrence and metastases between the two groups.Conclusions Laparoscopic surgery for colorectal cancer is effective and safe, causing tiny injury, having quick recovery and having the lower overall morbidity rate of postoperative complications and similar long-term survival with the open surgery.