Versus Open Colorectal Surgery: How Strong Is the Evidence?


Study


Type


N


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”


CLASICCb,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


60


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


60


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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May 2, 2020 | Posted by in GASTOINESTINAL SURGERY | Comments Off on Versus Open Colorectal Surgery: How Strong Is the Evidence?

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