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Published on: March 24, 2023
Hand-Assisted Laparoscopic Surgery Versus Conventional Laparoscopic Surgery for Colorectal Cancer: A Systematic
Xubing Zhang1,2, Qingbin Wu1,2, Tao Hu1,2
11 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .
Insights
Hand-assisted laparoscopic surgery (HALS) offers similar outcomes to conventional laparoscopic surgery (LAS) for colorectal cancer (CRC), with the exception of a slightly longer incision length. This finding suggests comparable safety and efficacy between the two surgical approaches for CRC patients.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Laparoscopic surgery is a standard approach for colorectal cancer (CRC).
- Hand-assisted laparoscopic surgery (HALS) offers a hybrid approach, combining benefits of open and laparoscopic surgery.
- Direct comparison of HALS and conventional laparoscopic surgery (LAS) for CRC is essential to guide clinical practice.
Purpose of the Study:
- To compare the intraoperative, postoperative, and survival outcomes of HALS versus LAS for colorectal cancer (CRC).
- To provide evidence-based insights into the efficacy and safety of HALS in CRC treatment.
Main Methods:
- Systematic literature search of PubMed, Embase, and Medline databases up to March 31, 2017.
- Meta-analysis of nine studies including 1307 patients comparing HALS and LAS for CRC.
- Evaluation of intraoperative (operative time, blood loss, incision length, etc.), postoperative (hospital stay, complications, etc.), and 5-year survival outcomes.
Main Results:
- HALS was associated with a significantly longer incision length compared to LAS.
- No statistically significant differences were observed between HALS and LAS in operative time, blood loss, transfusion rates, conversion rates, lymph node yield, length of hospital stay, time to first flatus or bowel movement, or overall postoperative complications.
- Survival outcomes, including 5-year survival, showed no significant difference between the two surgical methods.
Conclusions:
- Hand-assisted laparoscopic surgery (HALS) is a viable alternative to conventional laparoscopic surgery (LAS) for colorectal cancer (CRC).
- While HALS results in a longer incision, it demonstrates comparable intraoperative, postoperative, and survival outcomes to LAS.
- The choice between HALS and LAS for CRC may depend on surgeon preference and patient-specific factors, given the similar overall results.
Aim:
This meta-analysis aims to compare hand-assisted laparoscopic surgery (HALS) with conventional laparoscopic surgery (LAS) for colorectal cancer (CRC) in terms of intraoperative, postoperative, and survival outcomes.
Materials And Methods:
A systematic literature search with no limits was performed in PubMed, Embase, and Medline. The last search was performed on March 31, 2017. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, transfusion, conversion, and lymph nodes harvested), postoperative outcomes (length of hospital stay, time to first flatus, time to first bowel movement, postoperative complications, mortality, reoperation, ileus, anastomotic leakage, postoperative bleeding, wound infection, intra-abdominal abscess, urinary complication, cardiopulmonary complication, and readmission), and 5-year survival outcomes.
Results:
Nine articles published between 2007 and 2016 with a total of 1307 patients were enrolled in this meta-analysis. HALS was associated with longer length of incision. No differences were found for operative time, blood loss, transfusion, conversion, lymph nodes harvested, length of hospital stay, time to first flatus, time to first bowel movement, postoperative complications, mortality, reoperation, ileus, anastomotic leakage, postoperative bleeding, wound infection, intra-abdominal abscess, urinary complication, cardiopulmonary complication, readmission, or 5-year survival outcomes.
Conclusion:
Our meta-analysis demonstrated that HALS is similar to LAS for CRC surgery in terms of intraoperative, postoperative, and survival outcomes except for the longer length of incision.
