A meta-analysis and systematic review of perioperative outcomes of laparoscopic-assisted rectal resection (LARR) versus open rectal resection (ORR) for carcinoma

Memon, Muhammed A. and Yunus, Rossita M. and Memon, Breda and Awais, Aiman and Khan, Shahjahan (2018) A meta-analysis and systematic review of perioperative outcomes of laparoscopic-assisted rectal resection (LARR) versus open rectal resection (ORR) for carcinoma. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, 28 (6). pp. 337-348. ISSN 1530-4515

Abstract

Aims and objectives: The aim was to conduct a systematic review and meta-analysis of the randomized evidence to determine the relative merits of perioperative outcomes of laparoscopic-assisted (LARR) versus open rectal resection (ORR) for proven rectal cancer.

Materials and methods: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English-language randomized clinical trials comparing LARR and ORR. The meta-analysis was prepared in accordance with the PRISMA statement. Thirteen outcome variables were analyzed. Random effects meta-analyses were performed due to heterogeneity.

Results: A total of 14 randomized clinical trials that included 3843 rectal resections (LARR 2096, ORR 1747) were analyzed. The summary point estimates favored LARR for the intraoperative blood loss, commencement of oral intake, first bowel movement, and length of hospital stay. There was significantly longer duration of operating time of 38.29 minutes for the LARR group. Other outcome variables such as total complications, postoperative pain, postoperative ileus, abdominal abscesses, postoperative anastomotic leak, reintervention and postoperative mortality rates were found to have comparable outcomes for both cohorts.

Conclusions: LARR was associated with significantly reduced blood loss, quicker resumption of oral intake, earlier return of gastrointestinal function, and shorter length of hospital stay at the expense of significantly longer operating time. Postoperative morbidity and mortality and analgesia requirement for both these groups were comparable. LARR seems to be a safe and effective alternative to ORR; however, it needs to be performed in established colorectal units with experienced laparoscopic surgeons.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Permanent restricted access to Published version, in accordance with the copyright policy of the publisher.
Faculty / Department / School: Current - Faculty of Health, Engineering and Sciences - School of Agricultural, Computational and Environmental Sciences
Date Deposited: 16 Jan 2019 04:05
Last Modified: 01 Mar 2019 04:28
Uncontrolled Keywords: rectal carcinoma, anterior resection, rectal resection, open surgery, laparoscopic surgery, randomized controlled trials
Fields of Research : 11 Medical and Health Sciences > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified
01 Mathematical Sciences > 0104 Statistics > 010402 Biostatistics
Socio-Economic Objective: E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
E Expanding Knowledge > 97 Expanding Knowledge > 970101 Expanding Knowledge in the Mathematical Sciences
Identification Number or DOI: 10.1097/SLE.0000000000000589
URI: http://eprints.usq.edu.au/id/eprint/23308

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