Laparoscopic surgery can improve long-term overall survival (OS), compared with open surgery, in patients with rectal cancer, according to a meta-analysis published in JAMA Network Open

“The survival benefit of laparoscopic surgery is encouraging and supports the routine use of laparoscopic surgery for adult patients with rectal cancer in the era of minimally invasive surgery,” the researchers wrote. 

The team noted that many meta-analyses have been conducted to compare long-term outcomes of laparoscopic surgery and open surgery. However, the method of pooled analysis was “inappropriate” in most of these meta-analyses, according to the researchers. 


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With this in mind, the team performed an individual participant data meta-analysis using time-to-event data and focused on long-term survival outcomes. The analysis included 12 randomized clinical trials that encompassed 3709 participants. 

The 5-year estimated OS rate was 76.2% for patients who underwent laparoscopic surgery and 72.7% for those who underwent open surgery. The 5-year estimated disease-free survival (DFS) rates were 72.2% and 70.1%, respectively.

In a 1-stage meta-analysis, there was no significant difference in DFS between patients who underwent laparoscopic surgery and those who underwent open surgery (hazard ratio [HR], 0.92; 95% CI, 0.80-1.06; P=.26). On the other hand, OS was significantly better in the laparoscopic group (HR, 0.85; 95% CI, 0.74-0.97; P=.02). 

Results were similar in 2-stage meta-analyses. The pooled HR was 0.92 for DFS (95% CI, 0.80-1.06; P =.25) and 0.85 for OS (95% CI, 0.74-0.97; P =.02)

The researchers noted that several differences could explain the OS benefit for patients who underwent laparoscopic surgery, including improved recovery that allowed for earlier adjuvant therapy, lower stress responses, and higher levels of immune function. 

Reference

Kong M, Chen H, Shan K, Sheng H, Li L. Comparison of survival among adults with rectal cancer who have undergone laparoscopic vs open surgery: A meta-analysis. JAMA Netw Open. Published online May 9, 2022. doi:10.1001/jamanetworkopen.2022.10861