Laparoscopic Compared With Open Resection for Colorectal Cancer and Long-term Incidence of Adhesional Intestinal Obstruction and Incisional Hernia: A Systematic Review and Meta-analysis

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BACKGROUND:Incisional hernia and adhesional intestinal obstruction are important complications of laparoscopic and open resection for colorectal cancer. This is the largest systematic review of comparative studies on this topic.OBJECTIVE:This study aimed to investigate whether laparoscopic surgery decreases the incidence of incisional hernia and adhesional intestinal obstruction compared to open surgery for colorectal cancer.DATA SOURCES:Online databases PubMed, EMBASE, and the Cochrane Library were searched. Abstracts from the annual meetings of the American Society of Colon and Rectal Surgeons and the European Society of Coloproctology were performed to cover gray literature.STUDY SELECTION:We included both randomized and nonrandomized comparative studies.INTERVENTIONS:Laparoscopic resection was compared to open resection for patients with colorectal cancer.MAIN OUTCOMES MEASURES:The primary outcomes measured were incisional hernia and adhesional intestinal obstruction.RESULTS:Fifteen studies met inclusion criteria (6 randomized comparative studies/9 nonrandomized comparative studies); 84,172 patients. Meta-analysis showed decreased odds of developing incisional hernia in the laparoscopic cohort (OR, 0.79; 95% CI, 0.66–0.95; p = 0.01) but no difference in requirement for surgery (OR, 1.07; 95% CI, 0.64–1.79; p = 0.79). Similarly, there were decreased odds of developing adhesional intestinal obstruction in the laparoscopic cohort (OR, 0.81; 95% CI, 0.72–0.92, p = 0.001), but no difference in requirement for surgery (OR, 0.84; 95% CI, 0.53–1.35; p = 0.48).LIMITATIONS:Incisional hernia and adhesional intestinal obstruction were poorly defined in many studies.CONCLUSION:Laparoscopic surgery is associated with decreased odds of incisional hernias and adhesional intestinal obstructions compared with open surgery for colorectal cancer.

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