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A Meta-Analysis and Systematic Review of Perioperative Outcomes of Laparoscopic-assisted Rectal Resection (LARR) Versus Open Rectal Resection (ORR) for Carcinoma

Memon, Muhammed A., MBBS, MA, DCH, FACS, FRACS, FRCSI, FRCSEd, FRCSEng*,†,‡,§,∥; Yunus, Rossita M., PhD; Memon, Breda, RN, LLB, PGCEd, Dip Pract Mgt*; Awaiz, Aiman, MD, MBBS*; Khan, Shahjahan, PhD

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: December 2018 - Volume 28 - Issue 6 - p 337–348
doi: 10.1097/SLE.0000000000000589
Review Articles

Aims and Objectives: The aim was to conduct a systematic review and meta-analysis of the randomized evidence to determine the relative merits of perioperative outcomes of laparoscopic-assisted (LARR) versus open rectal resection (ORR) for proven rectal cancer.

Materials and Methods: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English-language randomized clinical trials comparing LARR and ORR. The meta-analysis was prepared in accordance with the PRISMA statement. Thirteen outcome variables were analyzed. Random effects meta-analyses were performed due to heterogeneity.

Results: A total of 14 randomized clinical trials that included 3843 rectal resections (LARR 2096, ORR 1747) were analyzed. The summary point estimates favored LARR for the intraoperative blood loss, commencement of oral intake, first bowel movement, and length of hospital stay. There was significantly longer duration of operating time of 38.29 minutes for the LARR group. Other outcome variables such as total complications, postoperative pain, postoperative ileus, abdominal abscesses, postoperative anastomotic leak, reintervention and postoperative mortality rates were found to have comparable outcomes for both cohorts.

Conclusions: LARR was associated with significantly reduced blood loss, quicker resumption of oral intake, earlier return of gastrointestinal function, and shorter length of hospital stay at the expense of significantly longer operating time. Postoperative morbidity and mortality and analgesia requirement for both these groups were comparable. LARR seems to be a safe and effective alternative to ORR; however, it needs to be performed in established colorectal units with experienced laparoscopic surgeons.

*South East Queensland Surgery (SEQS) and Sunnybank Obesity Centre, Sunnybank

School of Agricultural, Computing and Environmental Sciences, International Centre for Applied Climate Science, University of Southern Queensland, Toowoomba

Mayne Medical School, School of Medicine, University of Queensland, Brisbane

§Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia

Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK

Institute of Mathematical Sciences, University of Malaya, Kuala Lumpur, Malaysia

The authors declare no conflicts of interest.

Reprints: Muhammed A. Memon, MBBS, MA, DCH, FACS, FRACS, FRCS, FRCSI, FRCSEd, FRCSEng, South East Queensland Surgery and Sunnybank Obesity Centre, Suite 9, McCullough Centre, 259 McCullough Street, Sunnybank, Qld 4109, Australia (e-mail:

Received June 23, 2018

Accepted September 12, 2018

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