Laparoscopic versus open surgery: a systematic review evaluating Cochrane systematic reviews

Area of Science:

• Surgical Oncology
• Evidence-Based Medicine
• Systematic Review Methodology

Background:

• Laparoscopic surgical procedures (LSP) are increasingly favored for potential effectiveness and efficiency gains.
• This study evaluates Cochrane systematic reviews (CSRs) comparing LSP to open surgical procedures.
• It also assesses the quality and consistency of LSP evidence within CSRs over time and across surgical specialties.

Purpose of the Study:

• To synthesize evidence from CSRs on the comparative effectiveness of LSP versus open procedures.
• To analyze the quality, consistency, and reporting trends of LSP evidence in CSRs.
• To identify areas for improving the methodological rigor of future systematic reviews.

Main Methods:

• Searched the Cochrane Database for CSRs comparing LSP and open procedures (36 CSRs, 15 protocols identified).
• Evaluated clinical outcomes and conclusions of each CSR.
• Assessed CSR quality and completeness using PRISMA and AMSTAR criteria.
• Summarized reporting variations and trends across specialties and time.

Main Results:

• Weighted analysis of 36 CSRs indicated improved outcomes with LSP (OR 0.90; 95% CI 0.88, 0.92).
• Significant variation observed in patient criteria and endpoints across CSRs.
• Most individual CSRs found no significant difference (65.4%); 25.8% favored LSP, 8.9% favored open procedures.
• Undeclared conflicts of interest were noted in 25% of CSRs, potentially introducing bias.

Conclusions:

• CSR evidence generally supports a benefit for LSP, but clinical decisions require procedure-specific data.
• Identified variations in CSR design and reporting highlight needs for improved methodological transparency and standardization.
• Comprehensive documentation of non-financial conflicts of interest is crucial for enhancing CSR reliability.