A systematic review and meta-analysis of randomized and non-randomized studies comparing laparoscopic and open abdominoperineal resection for rectal cancer

Aim Evidence supporting the role of laparoscopy in abdominoperineal resection (APR) is limited. This study compared the short-term and long-term outcomes and complications associated with open and laparoscopic APR. Method The Medline, Cochrane and Embase databases were searched for publications comparing open and laparoscopic APR. The rates of local and distant recurrence of rectal cancer were compared as the primary end-point. The occurrence of complications related to the two procedures was studied as the secondary end-point. The adequacy of cancer resection and postoperative recovery were also compared in a secondary analysis. Combined and separate analyses were performed for randomized and non-randomized studies. Results Eight publications comparing open and laparoscopic APR were identified. The rates of local and distant disease recurrence were lower after laparoscopic surgery compared with open APR (odds ratio 2.736 and 1.994, 95% confidence interval 1.1376.584 and 1.0623.742, P=0.025 and P =0.032, respectively). Early postoperative complications were fewer after laparoscopic APR (OR 2.159, 95% CI 1.4263.269, P=0.000). No significant benefit of either technique was observed in the secondary analysis. Conclusion The long-term oncological benefits of laparoscopic APR are not convincingly superior to open surgery and need further validation. The laparoscopic approach is apparently associated with fewer postoperative complications, yet its role in improving the short-term outcomes is uncertain.