Laparoscopic versus Open Surgery for Colon Cancer: A Meta-analysis of 5-year Outcomes

Background: Colon cancer is one of the most common malignant tumors of digestive tract with a rather high incidence rate. Currently, surgery is the only radical therapy for colon cancer, while Laparoscopic colectomy (LAC) has become another focus since studies reported LAC could improve the short-time outcomes and quick recovery of patients compared with open colectomy (OC). However, it's still unclear whether LAC can better improve patients' long-time survival than OC. Objective: We aimed to perform a meta-analysis to answer whether the 5-year recurrence and survival rate after LAC are comparable to those reported after OC in patient with colon cancer. Methods: We searched Cochrane Library, PubMed, Embase, CBM, VIP, and CNKI for relevant studies. The time searched was from the establishment time of the databases to September 15, 2011. At the same time, we searched Google, Medical Martix and Baidu for more studies as well as a hand-search. We limited the language to English and Chinese. Two reviewers independently screened articles to identify randomized controlled trials (RCTs) according to the inclusion and exclusion criteria and assessed the methodological quality of included trials, and then extracted data. Meta-analysis was performed using RevMan5.0. Results: Five RCTs involving 2,695 patients reported long-term outcomes based on 5-year data and were included in the analysis. No significant differences between LAC and OC were found in the overall mortality (RR=0.94; 95% CI(0.82, 1.09); P=0.23, I2=21%), total recurrence rate (RR=0.94; 95% CI(0.81, 1.10); P=0.24, I2=27%), 5-year tumor free survival rate (RR=1.00, 95% CI(0.94, 1.06); P=0.96, I2=0%). and overall 5-year survival (RR=1.02; 95% CI(0.97, 1.07); P=0.55, I2=0%). Conclusions: This meta-analysis suggests that LAC was as effective and safe as OC for colon cancer.