Christos Athanasiou, Sonia Lockwood, Jonathan Robinson, Georgios Markides. Bradford Teaching Hospitals NHS Foundation Trust
Aim: All randomized controlled trials comparing laparoscopic versus open colectomy in colorectal malignancy have up-to-now excluded transverse colon malignancies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. This study aimed to systematically review the literature, establish the level of evidence and compare the laparoscopic (LTC) to the open (OTC) approach for transverse colonic cancer resections.
Method: The Scopus, Cochrane library and Pubmed databases were interrogated. Selected studies were critically appraised and the short term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study and year of publication was performed. Statistical heterogeneity and publication bias were also investigated.
Results: Nine case control trials with 1156 patients (610 in the LTC and 546 in the OTC) were included in the study. LTC was found to have shorter hospital stay [Weight mean difference (WMD) =-2.99 (-4.62, -1.37); P=0.003] and faster start of oral intake [WMD=-1.44 (-1.64, -1.23); P<0.00001], with longer operative time [WMD=40.35 (22.22, 58.47) ;P<0.0001]. No difference was found in relation to anastomotic leak [Odds Ratio (OR)=0.74 (0.33, 1.65) ;P=0.46], intra-abdominal abscess [OR=0.56 (0.23, 1.40);P=0.22], and lymph nodes harvested [WMD=-1.14 (-2.61, 0.33); P=0.13] outcomes, or in relation to oncological outcomes such as overall survival [HR=1.40 (0.63, 3.14) ;P=0.97], disease free survival [HR= 0.84 (0.58, 1.21) ;P=0.34], local recurrence [OR=1.13 (0.42, 3.07) ;P=0.81] or distant metastases [OR=0.68 (0.40, 1.16);P=0.16].
Conclusion: LTC provides significant short-term benefits with no increased morbidity and similar long-term oncological outcomes in relation to OTC in colorectal cancer surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80851
Program Number: P594
Presentation Session: Poster (Non CME)
Presentation Type: Poster