Laparoscopic versus open colectomy for locally advanced T4 colonic cancer: meta-analysis of clinical and oncological outcomes

Br J Surg. 2022 Mar 15;109(4):319-331. doi: 10.1093/bjs/znab464.

Abstract

Background: The aim of this study was to review the early postoperative and oncological outcomes after laparoscopic colectomy for T4 cancer compared with open surgery.

Method: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for any relevant clinical study comparing laparoscopic and open colectomy as treatment for T4 colonic cancer. The risk ratio (RR) with 95 per cent c.i. was calculated for dichotomous variables, and the mean difference (m.d.) with 95 per cent confidence interval for continuous variables. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was implemented for assessing quality of evidence (QoE).

Results: Twenty-four observational studies (21 retrospective and 3 prospective cohort studies) were included, analysing a total of 18 123 patients: 9024 received laparoscopic colectomy and 9099 underwent open surgery. Laparoscopic colectomy was associated with lower rates of mortality (RR 0.48, 95 per cent c.i. 0.41 to 0.56; P < 0.001; I2 = 0 per cent, fixed-effect model; QoE moderate) and complications (RR 0.61, 0.49 to 0.76; P < 0.001; I2 = 20 per cent, random-effects model; QoE very low) compared with an open procedure. No differences in R0 resection rate (RR 1.01, 1.00 to 1.03; P = 0.12; I2 = 37 per cent, random-effects model; QoE very low) and recurrence rate (RR 0.98, 0.84 to 1.14; P = 0.81; I2 = 0 per cent, fixed-effect model; QoE very low) were found.

Conclusion: Laparoscopic colectomy for T4 colonic cancer is safe, and is associated with better clinical outcomes than open surgery and similar oncological outcomes.

Plain language summary

Colonic cancer is a common condition, and in 10-20 per cent of patients the tumour has grown beyond the bowel wall or invaded other organs at diagnosis (called locally advanced colonic cancer). This study reviews the use of laparoscopic (minimally invasive surgery or keyhole surgery) to treat these locally advanced tumours. Medical databases were searched for research publications on the subject. In total, 24 studies (including data on 18 123 patients) comparing laparoscopic with traditional open surgery were identified. Analysing the data of the studies together found that laparoscopic surgery was associated with lower rates of mortality and surgical complications. No difference in survival or cancer recurrence was found.

Publication types

  • Meta-Analysis

MeSH terms

  • Colectomy / methods
  • Colonic Neoplasms* / surgery
  • Humans
  • Laparoscopy* / methods
  • Prospective Studies
  • Retrospective Studies