Laparoscopic versus open total mesorectal excision for rectal cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Colorectal cancer is a leading cause of cancer death globally.
• Laparoscopic surgery for colon cancer demonstrates superior short-term recovery and cosmetic results.
• The oncological safety and long-term benefits of laparoscopic rectal cancer surgery remain under investigation.

Purpose of the Study:

• To compare short- and long-term outcomes of laparoscopic total mesorectal excision (LTME) versus open total mesorectal excision (OTME) for rectal cancer.
• To assess oncological safety and patient recovery following LTME versus OTME.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing LTME and OTME.
• Searched Cochrane, MEDLINE, EMBASE, and ClinicalTrials.gov databases.
• Assessed study quality using CONSORT criteria and evidence quality using GRADE methods.

Main Results:

• 14 RCTs involving 3528 patients were included.
• LTME and OTME showed similar 5-year disease-free survival, local recurrence, and overall survival rates (moderate quality evidence).
• LTME resulted in shorter hospital stays, faster return of bowel function, fewer wound infections, and bleeding complications, with similar overall morbidity.

Conclusions:

• Laparoscopic total mesorectal excision (LTME) offers comparable long-term oncological outcomes to open total mesorectal excision (OTME) for rectal cancer.
• LTME provides significant short-term benefits, including faster recovery and reduced complications for non-locally advanced rectal cancer.
• Further long-term data from ongoing studies are needed for a more definitive analysis of survival and recurrence rates.