Laparoscopic vs open approach for transverse colon cancer. A systematic review and meta-analysis of short and long term outcomes.

BACKGROUND Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparoscopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes. METHODS Medline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated. RESULTS Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR) = 0.83 (0.56, 1.22); P = 0.34], disease free survival (p = 0.20), local recurrence (p = 0.81) or distant metastases (p = 0.24). LPA was found to have longer operative time [Weighted mean difference (WMD) = 45.00 (29.48, 60.52); P < 0.00001] with earlier establishment of oral intake [WMD = -1.68 (-1.84, -1.53); P < 0.00001] and shorter hospital stay [WMD = -2.94 (-4.27, -1.62); P = 0.0001]. No difference was found in relation to anastomotic leakage (p = 0.39), intra-abdominal abscess (p = 0.25), lymph nodes harvested (p = 0.17). CONCLUSIONS LPA seems to be safe with equivalent oncological outcomes to OPA and better short term outcomes in selected patient populations. High quality Randomized control trials are required to further investigate the role of laparoscopy in transverse colon cancer.

[1]  M. Kafousi,et al.  Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach , 2012, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[2]  M. Goel,et al.  Understanding survival analysis: Kaplan-Meier estimate , 2010, International journal of Ayurveda research.

[3]  N. Kim,et al.  Comparative study of oncologic outcomes for laparoscopic vs. open surgery in transverse colon cancer , 2014, Annals of surgical treatment and research.

[4]  J. M. Fernández-Cebrían,et al.  Laparoscopic colectomy for transverse colon carcinoma: a surgical challenge but oncologically feasible , 2013, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[5]  Z. Wang,et al.  Outcome of Laparoscopic Versus Open Resection for Transverse Colon Cancer , 2015, Journal of Gastrointestinal Surgery.

[6]  N. Nguyen,et al.  Outcomes of Conversion of Laparoscopic Colorectal Surgery to Open Surgery , 2014, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[7]  J. Fleshman,et al.  A comparison of laparoscopically assisted and open colectomy for colon cancer. , 2004, The New England journal of medicine.

[8]  K. Uchiyama,et al.  Effect of Previous Abdominal Surgery on Outcomes Following Laparoscopic Colorectal Surgery , 2013, Diseases of the colon and rectum.

[9]  G. Eide,et al.  Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study , 2016, Digestive Surgery.

[10]  S. Kitano,et al.  Short-Term Surgical Outcomes From a Randomized Controlled Trial to Evaluate Laparoscopic and Open D3 Dissection for Stage II/III Colon Cancer: Japan Clinical Oncology Group Study JCOG 0404 , 2014, Annals of surgery.

[11]  K. Uchiyama,et al.  Laparoscopic resection of transverse colon cancer at splenic flexure: technical aspects and results , 2016, Updates in Surgery.

[12]  S. Nagayama,et al.  Colon Cancer in the Splenic Flexure: Comparison of Short-term Outcomes of Laparoscopic and Open Colectomy , 2011, Surgical laparoscopy, endoscopy & percutaneous techniques.

[13]  W. Hohenberger,et al.  Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  D. Miskovic,et al.  Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta‐analysis , 2016, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[15]  Toshiharu Yamaguchi,et al.  Short-Term Outcomes of Laparoscopic Colectomy for Transverse Colon Cancer , 2010, Journal of Gastrointestinal Surgery.

[16]  R. Veldkamp,et al.  Laparoscopic surgery versus open surgery for colon cancer : short-term outcomes of a randomised trial , 2022 .

[17]  Philip Quirke,et al.  Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial , 2005, The Lancet.

[18]  I. Lee,et al.  A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer , 2009, Surgical Endoscopy.

[19]  M. Morino,et al.  Laparoscopic versus open resection for transverse colon cancer , 2015, Surgical Endoscopy.

[20]  Weidong Gao,et al.  Laparoscopic colectomy for transverse colon cancer: comparative analysis of short- and long-term outcomes. , 2015, International journal of clinical and experimental medicine.

[21]  Antoni Castells,et al.  Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial , 2002, The Lancet.

[22]  J. Yu,et al.  Long-Term Outcomes of Laparoscopic Surgery for Advanced Transverse Colon Cancer , 2014, Journal of Gastrointestinal Surgery.

[23]  J. Kinross,et al.  Complete mesocolic excision in colorectal cancer: a systematic review , 2015, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[24]  M. Sydes,et al.  Practical methods for incorporating summary time-to-event data into meta-analysis , 2007, Trials.

[25]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[26]  Byung Chun Kim,et al.  Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study , 2016, OncoTargets and therapy.

[27]  I. Hozo,et al.  Estimating the mean and variance from the median, range, and the size of a sample , 2005, BMC medical research methodology.

[28]  P. Quirke,et al.  Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. , 2008, The Lancet. Oncology.

[29]  D. Sargent,et al.  Laparoscopic Colectomy for Cancer Is Not Inferior to Open Surgery Based on 5-Year Data From the COST Study Group Trial , 2007, Annals of surgery.

[30]  P. Tugwell,et al.  The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses , 2014 .

[31]  Hyung-Jin Kim,et al.  Laparoscopic Surgery for Transverse Colon Cancer: Short- and Long-Term Outcomes in Comparison with Conventional Open Surgery. , 2015, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[32]  K. Uchiyama,et al.  Clinical outcomes of laparoscopic surgery for advanced transverse and descending colon cancer: a single-center experience , 2011, Surgical Endoscopy.

[33]  O. Zmora,et al.  Laparoscopic colectomy for transverse colon carcinoma , 2010, Techniques in Coloproctology.