Evidence based medicine and surgical approaches for colon cancer: Evidences, benefits and limitations of the laparoscopic vs open resection

AIM: To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection.

AIM:To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection.METHODS:Forty-seven manuscripts were reviewed,33 of which employed for meta-analysis according to the PRISMA guidelines.The results were differentiated according to the study design(prospective randomized trials vs case-control series)and according to the tu-mor’s location.Outcome measures included:(1)shortterm results(operating times,blood losses,bowel function recovery,post-operative pain,return to the oral intake,complications and hospital stay);(2)oncological adequateness(number of nodes harvested in the surgical specimens);and(3)long-term results(including the survivals’rates and incidence of incisional hernias)and(4)costs.RESULTS:Meta-analysis of trials provided evidences in support of the laparoscopic procedures for a several short-term outcomes including:a lower blood loss,an earlier recovery of the bowel function,an earlier return to the oral intake,a shorter hospital stay and a lower morbidity rate.Opposite the operating time has been confirmed shorter in open surgery.The same trend has been reported investigating case-control series and cancer by sites,even though there are some concerns regarding the power of the studies in this latter field due to the small number of trials and the small sample of patients enrolled.The two approaches were comparable regarding the mean number of nodes harvested and long-term results,even though these variables were documented reviewing the literature but were not computable for meta-analysis.The analysis of the costs documented lower costs for the open surgery,however just few studies investigated the incidence of postoperative hernias.CONCLUSION:Laparoscopy is superior for the majority of short-term results.Future studies should better differentiate these approaches on the basis of tumors’location and the post-operative hernias.