Laparoscopic Versus Conventional Open Abdominoperineal Resection for Rectal Cancer: An Updated Systematic Review and Meta-analysis

Background: Laparoscopic abdominoperineal resection (LAPR) for rectal cancer (RC) treatment is still controversial, so we conducted this meta-analysis comparing LAPR with conventional open abdominoperineal resection (OAPR) to explore the safety and feasibility of LAPR for RC treatment. Methods: A systematic literature search with no limits was performed in PubMed, and Ovid. The last search was performed on June 6, 2017. The outcomes of interests included intraoperative outcomes, pathological outcomes, postoperative outcomes, and survival outcomes. Results: Twenty-one articles published between 1997 and 2016 with a total of 20,343 patients were enrolled in this meta-analysis. Compared with OAPR, LAPR showed comparable operative time, less blood loss and intraoperative blood transfusion, smaller length of hospital day and postoperative hospital day, faster recovery of bowel functions, and less postoperative complications, especially less abdominal wound infection. As for pathological outcomes, LAPR was not inferior to OAPR. Besides, LAPR was comparable to OAPR in recurrence rate, 3-year survivals and 5-year survivals. Conclusions: LAPR can reduce postoperative complications, lead faster postoperative recovery. In addition, LAPR is not inferior to OAPR in terms of oncological clearance, recurrence rate, and long-time survivals. So LAPR is safe and feasible for RC treatment. Further, more perspective randomized trials can be conducted to compare LAPR and OAPR in the future.