Versus Open Colorectal Surgery: How Strong Is the Evidence?

Study

Type

Indications

Endpoint

Conclusion

COST (2007)

Fleshman et al. [7]

RCT non-inferiority

872

Colon cancer

Stage I–III

Time to recurrence

“Laparoscopic colectomy for curable colon cancer is not inferior to open surgery based on long-term oncologic endpoints”

COLOR (2005)

Veldkamp et al.^a

RCT non-inferiority

7% margin

1248

Colon cancer

Stage I–IV

3-yr DFS

“…the difference in disease-free survival between groups was small and, we believe, clinically acceptable, justifying the implementation of laparoscopic surgery into daily practice”

“Laparoscopic surgery [has]…similar rates of disease-free survival, overall survival and recurrences as open surgery at 10-year follow-up”

CLASICC^b,c (2005, 2012)

RCT

794

Colon and rectal cancer

Stage I–IV

Multiple

OS, DFS, LR

“…impaired short-term outcomes after laparoscopic-assisted anterior resection for cancer of the rectum do not yet justify its routine use”

“Long-term results…support the use of laparoscopic surgery for both colonic and rectal cancer”

ALCCaS (2018)

McCombie et al. [5]

RCT

601

Colon cancer

Stage I–III

5-year OS, DFS, freedom from recurrence

“… laparoscopic colorectal resection was not inferior to open colorectal resection in direct measures of survival and recurrence”

COREAN (2014)

Jeong et al. [4]

RCT non-inferiority

15% margin

340

Rectal cancer

Stage II–III

3-year DFS

“…laparoscopic resection for locally advanced rectal cancer after preoperative chemoradiotherapy provides similar outcomes for disease-free survival as open resection, thus justifying its use”

COLOR II (2015) [13]

RCT non-inferiority

5% margin

1044

Rectal cancer

Stage I–III

3-year LR

“…laparoscopic surgery is as safe and effective as open surgery in patients with rectal cancers without invasion of adjacent tissues”

Z6051 (2015, 2018)

Fleshman et al. [8, 9]

RCT non-inferiority

6% margin

486

Rectal cancer

Stage I–III

Composite pathology

2-year DFS, recurrence

“Laparoscopic assisted resection of rectal cancer was not found to be significantly different to OPEN resection of rectal cancer based on the outcomes of DFS and recurrence”

AlaCaRT (2018)

Stevenson et al. [11]

RCT non-inferiority

8% margin

475

Rectal cancer

(0–15 cm)

Stage I–IV

Composite pathology

2-year LR, DFS

“Laparoscopic surgery for rectal cancer did not differ significantly from open surgery in effects on 2-year recurrence or DFS and OS”

Maartense et al. (2006)^d

RCT

Ileocolic Crohn’s disease

3-month QoL

“QoL …was not different for laparoscopic-assisted compared with the open ileocolic resection, morbidity, hospital stay, and costs were significantly lower”

Milsom et al. (2001) [35]

Stocchi et al. (2008)^e

RCT

Ileocolic Crohn’s disease

Recurrence

Postoperative complications

“Laparoscopic ileocolectomy is at least comparable to open ileocolectomy…”

Sigma trial

Klarenbeek et al. ^f (2009)

RCT

104

Diverticulitis

Mortality

Postoperative complications

“Laparoscopic surgery was associated with a 15.4% reduction in major complication rates, less pain, improved quality of life, and shorter hospitalization at the cost of a longer operating time”

Gervaz et al. (2010, 2011)^g,h

RCT

113

Diverticulitis

Postoperative pain

Duration of ileus

duration of LOS

“Laparoscopic sigmoid resection is associated with a 30% reduction in duration of postoperative ileus and hospital stay”

DFS disease-free survival, OS overall survival, LR local recurrence, RCT randomized controlled trial, QoL quality of life, LOS length of hospital stay

^aVeldkamp et al. [38]

^bGuillou et al. [39]

^cGreen et al. [40]

^dMaartense et al. [41]

^eStocchi et al. [42]

^fKlarenbeek et al. [37]

^gGervaz et al. [36]

^hGervaz et al. [43]

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