Laparoscopic surgery: A better option for rectal cancer patients, shows meta-analysis

A similar Disease-Free Survival (DFS) but significantly better Overall Survival (OS) was found for patients who have undergone laparoscopic surgery compared with open surgery for rectal cancer, according to the meta-analysis published in JAMA Network Open.

Rectal cancer is currently one of the leading causes of cancer-related deaths worldwide.

Neoadjuvant chemoradiotherapy has been helping with a lot of progress in treatment. However, surgery is still the most important treatment for such patients.

Several worldwide randomized clinical trials (RCTs) conducted over the last 15 years have indicated that laparoscopic and open surgery for rectal cancer had comparable long-term outcomes.

A recent meta-analysis performed by Asian researchers tried to compare the long-term oncologic outcomes of laparoscopic and open surgery for patients with rectal cancer.

"It is necessary to perform a meta-analysis to obtain enough power to support or oppose laparoscopic surgery for patients with rectal cancer in terms of long-term outcomes," the authors remarked.

This meta-analysis was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline for individual participant data development groups.

Individual participant data on DFS and OS were extracted from the published Kaplan-Meier survival curves.

One-stage and 2-stage meta-analyses were performed.

The meta-analysis included RCTs that compared laparoscopic surgery with open surgery for patients with rectal cancer and reported the outcome of disease-free survival (DFS) or overall survival (OS).

The exclusion criteria used were (1) non-RCTs, (2) studies without long-term survival outcomes of interest, and (3) studies that did not report Kaplan-Meier survival curves.

The following points were noted in the meta-analysis:

1. The reconstructed survival curves for the combined population showed that the 5-year estimated DFS rates were 72.2% for the laparoscopic group and 70.1% for the open surgery group.

2. The 5-year estimated OS rates were 76.2% for the laparoscopic group and 72.7% for the open surgery group.

3. DFS had a nonsignificant HR of 0.92 suggesting that the results in both groups were comparable.

4. However, OS was significantly better in the laparoscopic group.

"These findings address concerns regarding the effectiveness of laparoscopic surgery and support the routine use of laparoscopic surgery for patients with rectal cancer," the authors noted.

"In addition, the lower stress responses and higher levels of immune function among patients undergoing minimally invasive surgery may contribute to the long-term survival advantage of laparoscopic rectal surgery compared with open surgery," they added.

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