Laparoscopic Versus Open Rectectomy for Rectal Cancer: A Meta-analysis of Randomized Controlled Trials on Recurrence and Mortality

Objective To compare the recurrence and mortality between laparoscopic and conventional open rectectomy for rectal cancer with meta-analysis. Methods Eligible articles were identifi ed using MEDLINE, EMBASE and Cochrane database between January 1991 and October 2012 at the terms of laparoscopy, surgery, minimal invasive, rectectomy, rectal neoplasms and randomized controlled trial. Prospective randomized control trials（RCTs）were eligible if they included patients with rectal cancer treated by laparoscopic surgery and open surgery followed-up by recurrence and mortality. Data were extracted from these trials by two independent reviewers. RevMan5 was used to statistically analyze the suitable researches. Results There are 12 RCTs with recurrence and mortality information of 2259 patients were involved, 1158 cases of laparoscopic resection for rectal cancer, LRR group and 1101 cases of open resection for rectal cancer, ORR group. In the combined results, no signifi cant difference was found in overall recurrence rate (OR: 0.92，95%CI：0.66 to 1.28，P=0.61), local recurrence rate (OR: 0.79，95%CI：0.49 to 1.28，P=0.34), distant metastasis (OR: 0.87，95%CI：0.59 to 1.27，P=0.47), port-site or wound-site recurrence rate (OR: 1.34，95%CI：0.07 to 24.10，P=0.84), overall mortality rate（OR: 0.80，95%CI: 0.60 to 1.07，P=0.13) and cancer-related mortality rate（OR: 0.71，95%CI：0.45 to 1.12，P=0.14) between the laparoscopic surgery and open surgery group????Conclusion The recurrence and mortality rates for patients with rectal cancer treated by laparoscopic surgery are not significantly different from those by open surgery. Longer follow-up RCTs will further defi ne the outcomes by comparing the two techniques in the treatment of rectal cancer.