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Evidence summaries

Laparoscopic Versus Open Total Mesorectal Excision for Rectal Cancer

Laparoscopic total mesorectal excision (LTME) appears to have similar effects to open TME on long term survival outcomes for the treatment of rectal cancer, but it appears to lead to better short-term post-surgical outcomes in terms of recovery for non-locally advanced rectal cancer. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 14 studies with a total of 3528 subjects.

Laparoscopic and open total mesorectal excision (TME) have similar effects on five-year disease-free survival (OR 1.02; 95% CI 0.76 to1.38, 4 studies, N = 943). The estimated effects of laparoscopic and open TME on local recurrence and overall survival are similar (local recurrence: OR 0.89; 95% CI 0.57 to1.39 and overall survival rate: OR 1.15; 95% CI 0.87 to1.52). The number of resected lymph nodes and surgical margins were similar between the two groups. For the short-term results, length of hospital stay was reduced by two days (95% CI -3.22 to -1.10), and the time to first defecation was shorter in the LTME group (-0.86 days; 95% CI -1.17 to -0.54). 30 days morbidity were similar in both groups (OR 0.94; 95% CI 0.8 to 1.1). There were fewer wound infections (OR 0.68; 95% CI 0.50 to 0.93) and fewer bleeding complications (OR 0.30; 95% CI 0.10 to 0.93) in the LTME group. There was no clear evidence of any differences in quality of life after LTME or OTME regarding functional recovery, bladder and sexual function. The costs were higher for LTME with differences up to GBP 2000 for direct costs only.

Comment: The quality of evidence is downgraded by imprecise results.

    References

    • Vennix S, Pelzers L, Bouvy N et al. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 2014;(4):CD005200. [PubMed].

Primary/Secondary Keywords