Export file:


  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text


  • Citation Only
  • Citation and Abstract

Short-term outcome of laparoscopic surgery versus open surgery on colon carcinoma: A meta-analysis

1 Department of Thyroid and Gastrointestinal Surgical Oncology, Shenyang Fifth People Hospital, Shenyang 110023, China
2 Department of Obstetrics and Gynecology, Shenyang Yuhong District People’s Hospital, Shenyang 110141, China

Special Issues: Advanced Big Data Analysis for Precision Medicine

Objective: The aim of this article is to compare the oncological outcomes of laparoscopic and open resection for colon cancer. Method: Search the publications on comparison the efficacy of laparoscopic surgery comparison with open surgery in treatment outcomes of colon cancer to May, 2018. After rigorous reviewing on quality, the data was extracted from eligible trials. All trials analyzed the summary hazard ratios (HRs) of the endpoints of interest, including intraoperative and postoperative outcomes. Results: A total of 13 trials were met our inclusion criteria. With the pooled result of duration of surgery indicate that laparoscopic surgery was associated with a trend longer operate time (SMD = 0.58, 95% CI 0.17–0.99; P=0.005) , shorter length of hospital stay (SMD = −0.57, 95% CI −1.00–−0.15; P = 0.008) and postoperative hospital stay (SMD = −0.66, 95% CI −0.99–−0.33; P = 0.0001) , less blood loss (SMD = −0.68, 95% CI −1.12–−0.24; P = 0.002), shorter incision length (SMD = −4.61, 95% CI −5.79–−3.43; P<=0.00001 and less wound infection (OR = 0.30, 95% CI 0.13–0.67; P = 0.004). However, there were no differences in the number of lymph nodes harvested (P = 0.17), ileus (P = 0.91), pulmonary infection (P = 0.22) and postoperative complications (P = 0.24) between the 2 groups. Conclusion: Laparoscopic surgery had similar intraoperative and postoperative recovery parameters to those of the patients in the open group. The patients treated with laparoscopic had a trend longer operate time, shorter hospital stays, less intra-operative blood loss, faster recovery and lower incidence of wound infection. Whether it can be expected to be a standardization operation method for colon carcinoma still need more random clinical trials to be verified.
  Article Metrics


1. G. J. Zhang, T. Zhou, H. P. Tian, et al., High expression of ZEB1 correlates with liver metastasis and poor prognosis in colorectal cancer, Oncol. Lett., 5 (2013), 564−568.

2. L. A. Torre, F. Bray, R. L. Siegel, et al., Global cancer statistics, 2012, CA Cancer J. Clin., 65 (2015), 87−108.

3. Q. B. Wu, M. Wang, T. Hu, et al., Prognostic role of the lymphocyte-to-monocyte ratio in patients undergoing resection for nonmetastatic rectal cancer, Medicine (Baltimore), 95 (2016), e4945.

4. E. J. Hazebroek, COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer, Surg. Endosc., 16 (2002), 949−953.

5. J. Fleshman, D. J. Sargent, E. Green, et al., Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial, Ann. Surg., 246 (2007), 655−662; discussion 662−654.

6. F. Gao, Y. F. Cao and L. S. Chen, Meta-analysis of short-term outcomes after laparoscopic resection for rectal cancer, Int. J. Colorectal Dis., 21 (2006), 652−656.

7. N. Pecorelli, S. Amodeo, M. Frasson, et al., Ten-year outcomes following laparoscopic colorectal resection: results of a randomized controlled trial, Int. J. Colorectal Dis., 31 (2016), 1283−1290.

8. J. C. Kang, M. H. Chung, P. C. Chao, et al., Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study, Surg. Endosc., 18 (2004), 577−581.

9. C. C. Chung, D. C. Ng, W. W. Tsang, et al., Hand-assisted laparoscopic versus open right colectomy: a randomized controlled trial, Ann. Surg., 246 (2007), 728−733.

10. A. G. Aalbers, S. S. Biere, M. I. van Berge Henegouwen, et al., Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis, Surg Endosc., 22 (2008), 1769−1780.

11. I. Yang, R. P. Boushey and P. W. Marcello, Hand-assisted laparoscopic colorectal surgery, Tech. Coloproctol., 17 Suppl 1 (2013), S23−27.

12. A. G. Aalbers, A. Doeksen, M. I. Van Berge Henegouwen, et al., Hand-assisted laparoscopic versus open approach in colorectal surgery: a systematic review, Colorectal Dis., 12 (2010), 287−295.

13. J. P. Higgins and S. G. Thompson, Quantifying heterogeneity in a meta-analysis, Stat. Med., 21 (2002), 1539−1558.

14. J. P. Higgins, S. G. Thompson, J. J. Deeks, et al., Measuring inconsistency in meta-analyses, Bmj, 327 (2003), 557−560.

15. R. Veldkamp, E. Kuhry, W. C. Hop, et al., Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial, Lancet Oncol., 6 (2005), 477−484.

16. R. U. Osarogiagbon, O. Ogbeide, E. Ogbeide, et al., Hand-assisted laparoscopic colectomy compared with open colectomy in a nontertiary care setting, Clin. Colorectal Cancer, 6 (2007), 588−592.

17. Y. Takakura, M. Okajima, M. Yoshimitsu, et al., Hybrid hand-assisted colectomy for transverse colon cancer: a useful technique for non-expert laparoscopic surgeons, World J. Surg., 33 (2009), 2683−2687.

18. Q. S. Sheng, J. J. Lin, W. B. Chen, et al., Hand-assisted laparoscopic versus open right hemicolectomy: short-term outcomes in a single institution from China, Surg. Laparosc. Endosc. Percutan. Tech., 22 (2012), 267−271.

19. Z. Liu, G. Y. Wang, Y. G. Chen, et al., Cost comparison between hand-assisted laparoscopic colectomy and open colectomy, J. Laparoendosc. Adv. Surg. Tech. A, 22 (2012), 209−213.

20. S. E. Nam, E. J. Jung, C. G. Ryu, et al., Feasibility of hand-assisted laparoscopic surgery as compared to open surgery for sigmoid colon cancer: a case-controlled study, Ann. Coloproctol., 29 (2013), 17−21.

21. J. H. Sim, E. J. Jung, C. G. Ryu, et al., Short-term Outcomes of Hand-Assisted Laparoscopic Surgery vs. Open Surgery on Right Colon Cancer: A Case-Controlled Study, Ann. Coloproctol., 29 (2013), 72−76.

22. Z. Li, D. Li, Z. Jie, et al., Comparative Study on Therapeutic Efficacy Between Hand-Assisted Laparoscopic Surgery and Conventional Laparotomy for Acute Obstructive Right-Sided Colon Cancer, J. Laparoendosc. Adv. Surg. Tech. A, 25 (2015), 548−554.

23. Y. Wang, C. Zhang, Y. F. Feng, et al., Comparison of short-term outcomes between laparoscopic-assisted and open complete mesocolic excision (CME) for the treatment of transverse colon cancer, Chin. Clin. Oncol., 6 (2017), 6.

24. S. Kitano, M. Inomata, J. Mizusawa, et al., Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial, Lancet Gastroenterol. Hepatol., 2 (2017), 261−268.

25. Q. S. Sheng, Z. Pan, J. Chai, et al., Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches, Ann. Surg. Treat. Res., 92 (2017), 90−96.

26. W. Hohenberger, K. Weber, K. Matzel, et al., Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome, Colorectal Dis., 11 (2009), 354-364; discussion 364−355.

27. Q. Liu, D. Luo, P. Lian, et al., Reevaluation of laparoscopic surgery's value in pathological T4 colon cancer with comparison to open surgery: A retrospective and propensity score-matched study, Int. J. Surg., 53 (2018), 12−17.

28. R. R. Cima, R. Pendlimari, S. D. Holubar, et al., Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients, Dis. Colon Rectum, 54 (2011), 1076−1081.

29. A. Darzi, Hand-assisted laparoscopic colorectal surgery, Surg Endosc, 14 (2000), 999−1004.

30. V. Datta, S. Bann, J. Hernandez, et al., Objective assessment comparing hand-assisted and conventional laparoscopic surgery, Surg. Endosc., 21 (2007), 414−417.

31. P. W. Marcello, J. W. Fleshman, J. W. Milsom, et al., Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial, Dis. Colon Rectum, 51 (2008), 818−826; discussion 826−818.

32. D. K. Chan, C. S. Chong, B. Lieske, et al., Laparoscopic resection for rectal cancer: what is the evidence?, Biomed Res. Int., 2014 (2014), 347810.

33. P. J. Guillou, P. Quirke, H. Thorpe, et al., Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial, Lancet, 365 (2005), 1718−1726.

34. A. M. Lacy, J. C. Garcia-Valdecasas, S. Delgado, et al., Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial, Lancet, 359 (2002), 2224−2229.

35. H. Nelson, D. J. Sargent, H. S. Wieand, et al., A comparison of laparoscopically assisted and open colectomy for colon cancer, N. Engl. J. Med., 350 (2004), 2050−2059.

36. S. S. Ng, R. Y. Yiu, J. C. Li, et al., Emergency laparoscopically assisted right hemicolectomy for obstructing right-sided colon carcinoma, J. Laparoendosc. Adv. Surg. Tech. A, 16 (2006), 350−354.

37. K. Nakajima, S. W. Lee, C. Cocilovo, et al., Laparoscopic total colectomy: hand-assisted vs standard technique, Surg. Endosc., 18 (2004), 582−586.

38. E. Lezoche, F. Feliciotti, M. Guerrieri, et al., Laparoscopic versus open hemicolectomy, Minerva. Chir., 58 (2003), 491−502, 502−497.

39. C. Ringley, Y. K. Lee, A. Iqbal, et al., Comparison of conventional laparoscopic and hand-assisted oncologic segmental colonic resection, Surg. Endosc., 21 (2007), 2137−2141.

40. J. Ding, Y. Xia, G. Q. Liao, et al., Hand-assisted laparoscopic surgery versus open surgery for colorectal disease: a systematic review and meta-analysis, Am. J. Surg., 207 (2014), 109−119.

41. H. Wang, X. Chen, H. Liu, et al., Laparoscopy-assisted colectomy as an Oncologically safe alternative for patients with stage T4 Colon Cancer: a propensity-matched cohort study, BMC Cancer, 18 (2018), 370.

42. F. L. Liu, J. J. Lin, F. Ye, et al., Hand-assisted laparoscopic surgery versus the open approach in curative resection of rectal cancer, J. Int. Med. Res., 38 (2010), 916−922.

43. S. B. Orenstein, H. L. Elliott, L. A. Reines, et al., Advantages of the hand-assisted versus the open approach to elective colectomies, Surg. Endosc., 25 (2011), 1364−1368.

44. C. C. Chiu, Letter 1: Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer (Br J Surg 2009; 96: 1458-1467), Br. J. Surg., 97 (2010), 789; author reply 790−781.

45. M. D. Johnson and R. M. Walsh, Current therapies to shorten postoperative ileus, Cleve. Clin. J. Med., 76 (2009), 641−648.

46. K. Holte and H. Kehlet, Postoperative ileus: a preventable event, Br. J. Surg., 87 (2000), 1480−1493.

47. A. Luckey, E. Livingston and Y. Tache, Mechanisms and treatment of postoperative ileus, Arch. Surg., 138 (2003), 206−214.

48. A. Venara, M. Neunlist, K. Slim, et al., Postoperative ileus: Pathophysiology, incidence, and prevention, J. Visc. Surg., 153 (2016), 439−446.

49. M. A. Polacek and A. S. Close, The effect of antibiotic bowel preparation and peritoneal irrigation on the duration of post-operative ileus, Am. J. Surg., 105 (1963), 768−770.

50. W. R. Spanjersberg, J. D. van Sambeeck, A. Bremers, et al., Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme, Surg. Endosc., 29 (2015), 3443−3453.

51. G. M. Lloyd, R. Kirby, D. M. Hemingway, et al., The RAPID protocol enhances patient recovery after both laparoscopic and open colorectal resections, Surg. Endosc., 24 (2010), 1434−1439.

52. J. C. Reurings, W. R. Spanjersberg, H. J. Oostvogel, et al., A prospective cohort study to investigate cost-minimisation, of Traditional open, open fAst track recovery and laParoscopic fASt track multimodal management, for surgical patients with colon carcinomas (TAPAS study), BMC Surg., 10 (2010), 18.

53. N. de'Angelis, G. C. Vitali, F. Brunetti, et al., Laparoscopic vs. open surgery for T4 colon cancer: A propensity score analysis, Int. J. Colorectal Dis., 31 (2016), 1785−1797.

54. J. Kang, S. H. Baik, K. Y. Lee, et al., Outcomes of laparoscopic surgery in pathologic T4 colon cancers compared to those of open surgery, Int. J. Colorectal Dis., 32 (2017), 531−538.

55. I. Y. Kim, B. R. Kim and Y. W. Kim, The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer, Surg. Endosc., 30 (2016), 1508−1518.

56. P. J. Shukla, K. Trencheva, C. Merchant, et al., Laparoscopic resection of t4 colon cancers: is it feasible? Dis. Colon Rectum., 58 (2015), 25−31.

© 2019 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Article outline

Show full outline
Copyright © AIMS Press All Rights Reserved