Value of laparoscopy questioned in rectal cancer
medwireNews: Patients with rectal cancer undergoing laparoscopic rectal resection (LRR) have a significantly higher risk for achieving a noncomplete mesorectal excision than do those undergoing open rectal resection (ORR), meta-analysis data show.
Furthermore, LRR offers no benefit over ORR in terms of other pathologic variables including circumferential resection margin (CRM) involvement rates, report Nicola de’Angelis (Université Paris Est–Créteil, France) and colleagues in JAMA Surgery.
“These pathologic findings challenge the oncologic safety of laparoscopy for the treatment of rectal cancer”, the authors remark.
The analysis included 14 randomized controlled trials (RCTs) with 4034 patients who underwent surgery between 1993 and 2014.
Five of the studies reported the rate of noncomplete (nearly complete and incomplete) mesorectal excision, and showed that it was significantly higher in the 1354 patients undergoing LRR than in the 998 patients undergoing ORR at 13.2% versus 10.4%, giving a relative risk of 1.31.
Nine studies defined a positive CRM as 1 mm or less from the closest tumor to the cut edge of the tissue, in line with the current authors’ criteria. In these studies, the positive CRM rate did not differ significantly between the 1697 patients undergoing LRR and the 1292 patients undergoing ORR, at 7.9% versus 6.1%.
In addition, there were no significant differences between the two surgical techniques in the rate of distal resection margin involvement, the mean number of lymph nodes retrieved, the mean distance to the distal margin, and the mean distance to radial margins.
de’Angelis and co-authors say that their findings “dampen enthusiasm in support of laparoscopy as an oncologically safe approach for the treatment of rectal cancer.”
“However, the long-term results of the ongoing RCTs are awaited to provide a definitive response to the question of whether these results have an influence on disease-free and overall patient survival.”
By Laura Cowen
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