Laparoscopic versus open colectomy for locally advanced T4 colonic cancer: meta-analysis of clinical and oncological outcomes. Issue 4 (8th March 2022)

• Record Type: Journal Article
• Authors: Podda, Mauro; Pisanu, Adolfo; Morello, Alessia; Segalini, Edoardo; Jayant, Kumar; Gallo, Gaetano; Sartelli, Massimo; Coccolini, Federico; Catena, Fausto; Di Saverio, Salomone
• Is Part Of: British journal of surgery. Volume 109:Issue 4(2022)
• Page Start: 319
• Page End: 331
• Publication Date: 2022-03-08
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab464
• Languages: English
• ISSNs: 0007-1323

Abstract

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; I 2 = 0 per cent, fixed-effect model; QoE moderate) and complications (RR 0.61, 0.49 to 0.76; P < 0.001; I 2 = 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; I 2 = 37 per cent, random-effects model; QoE very low) and recurrence rate (RR 0.98, 0.84 to 1.14; P = 0.81; I 2 = 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. Lay 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. Abstract : Advantages of the laparoscopic technique for patients with pT4 colonic cancer in terms of mortality, postoperative morbidity, and Clavien–Dindo grade III–IV complication have been shown in the present meta-analysis, with an overall low quality of evidence. The absence of a statistically significant difference in surgical radicality, including R0 curative resection, positive margin rates, and recurrence, although limited by low quality of evidence, confirmed the reliability of the laparoscopic technique from an oncological point of view. Together, these findings suggest that laparoscopic colectomy appears to be safe for selected pT4 colonic cancers, if performed in centres with expertise in minimally invasive colorectal surgery.