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Outcomes following open versus laparoscopic multi-visceral resection for locally advanced colorectal cancer: A systematic review and meta-analysis

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Abstract

Background

This meta-analysis aims to compare morbidity, mortality, oncological safety, and survival outcomes after laparoscopic multi-visceral resection (MVR) of the locally advanced primary colorectal cancer (CRC) compared with open surgery.

Materials and methods

A systematic search of multiple electronic data sources was conducted, and all studies comparing laparoscopic and open surgery in patients with locally advanced CRC undergoing MVR were selected. The primary endpoints were peri-operative morbidity and mortality. Secondary endpoints were R0 and R1 resection, local and distant disease recurrence, disease-free survival (DFS), and overall survival (OS) rates. RevMan 5.3 was used for data analysis.

Results

Ten comparative observational studies reporting a total of 936 patients undergoing laparoscopic MVR (n = 452) and open surgery (n = 484) were identified. Primary outcome analysis demonstrated a significantly longer operative time in laparoscopic surgery compared with open operations (P = 0.008). However, intra-operative blood loss (P<0.00001) and wound infection (P = 0.05) favoured laparoscopy. Anastomotic leak rate (P = 0.91), intra-abdominal abscess formation (P = 0.40), and mortality rates (P = 0.87) were comparable between the two groups. Moreover the total number of harvested lymph nodes, R0/R1 resections, local/distant disease recurrence, DFS, and OS rates were also comparable between the groups.

Conclusion

Although inherent limitations exist with observational studies, the available evidence demonstrates that laparoscopic MVR in locally advanced CRC seems to be a feasible and oncologically safe surgical option in carefully selected cohorts.

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Author notes

  1. Shafquat Zaman and Pratik Bhattacharya had equal contribution proposing joint first authorship.

Authors and Affiliations

  1. Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK

    Shafquat Zaman, Pratik Bhattacharya, Fang Yi Cheung & Rajeev Peravali

  2. Department of General Surgery, Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK

    Ali Yasen Y Mohamedahmed

  3. Institute of Cancer and Genomic Science, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, UK

    Kamila Rakhimova

  4. Department of General Surgery, ASUR Marche, Hospital of San Benedetto del Tronto (AP), AV5, San Benedetto del Tronto, Italy

    Salomone Di Saverio

  5. Department of General Surgery, The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK

    Akinfemi Akingboye

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Contributions

Study conception and design: SZ, PB, SDS, and AA. Acquisition of data: PB, KR, and AYYM. Analysis and interpretation of data: PB, KR, AYYM, and FYC. Drafting of manuscript: all authors. Critical revision of manuscript: all authors. Approval of final manuscript: all authors.

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Correspondence to Ali Yasen Y Mohamedahmed.

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Appendix

Appendix

Table 4 Resected organs/tissue as part of MVR surgery in locally advanced colorectal cancer
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Zaman, S., Bhattacharya, P., Mohamedahmed, A.Y. et al. Outcomes following open versus laparoscopic multi-visceral resection for locally advanced colorectal cancer: A systematic review and meta-analysis. Langenbecks Arch Surg 408, 98 (2023). https://doi.org/10.1007/s00423-023-02835-2

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