84 - Freie Mitteilung
17. Mai 2019, 08:15 - 09:45, Bellavista 5, 6. OG
Meta-analysis of randomized controlled trials of surgery for rectal cancer
G. Peros1, C. Simillis2, N. Lal2, S. Thoukididou2, C. Kontovounisios2, J. Smith2, R. Hompes3, M. Adamina1, P. Tekkis2, Presenter: G. Peros1 (1Winterthur, 2London/UK, 3Amsterdam/NL)
The mainstay of treatment of rectal cancer includes total mesorectal excision (TME) of the rectum, classically performed by an open approach. Over time laparoscopic, robotic, and transanal approaches have been introduced. While studies have underlined the advantages of minimally invasive surgical treatment, concerns have been raised regarding the quality of oncological resection. The present analysis compares surgical approaches for rectal cancer.
A systematic literature review and Bayesian network meta-analysis of randomized controlled trials was performed, providing the best possible evidence for the appraisal of contemporary surgical treatment of rectal cancer.
29 randomized controlled trials were included reporting on 6’237 participants, comparing: open vs laparoscopic vs robotic vs transanal mesorectal excision. No significant differences were identified between treatments in intraoperative morbidity, conversion rate, overall postoperative morbidity, grade III/IV morbidity, reoperation, anastomotic leak, nodes retrieved, involved distal margin, 5-year overall survival, and locoregional recurrence. Operative blood loss was significantly less with laparoscopic surgery compared to open, and with robotic surgery compared to open and laparoscopic. Robotic surgery resulted in longer operative time compared to open, laparoscopic, and transanal, and the laparoscopic operative time was longer compared to open. Open surgery resulted in more wound infections compared to laparoscopic and robotic. Time to bowel movement was longer with open surgery compared to laparoscopic and robotic. Hospital stay was longer after open surgery compared to laparoscopic and robotic, and after laparoscopic compared to robotic. Noteworthy, laparoscopic surgery resulted in more incomplete or nearly complete mesorectal excisions compared to open, and in more involved circumferential resection margins compared to transanal. Robotic surgery resulted in longer distal resection margin compared to open, laparoscopic, and transanal techniques.
The different surgical techniques result in comparable perioperative morbidity and long-term survival. The laparoscopic and robotic approaches improve postoperative recovery, and the open and transanal approaches may improve oncological resection. Technique selection should be based on expected benefits by individual patient.