Laparoscopic-assisted resection of colorectal malignancies: A systematic review

Objective To compare the safety and efficacy of laparoscopic-assisted resec tion of colorectal malignancies with open colectomy. Methods Two search strategies were devised to retrieve literature from the Medline, Current Contents, Embase, and Cochrane Library databases until Jul y 1999. Inclusion of papers was determined using a predetermined protocol, independent assessments by two reviewers, and a final consensus decision. E nglish language papers were selected. Acceptable study designs included ran domized controlled trials, controlled clinical trials, case series, or case reports. Fifty-two papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding, and chance. Results Little high-level evidence was available. Laparoscopic resection of colorectal malignancy was more expensive and time-consuming, but little ev idence suggests high rates of port site recurrence. The new procedure's adv antages revolve around early recovery from surgery and reduced pain, Conclusions The evidence base for laparoscopic-assisted resection of colore ctal malignancies is inadequate to determine the procedure's safety and eff icacy. Because of inadequate evidence detailing circumferential marginal cl earance of tumors and the necessity of determining a precise incidence of c ardiac and other major complications, along with wound and port site recurr ence, it is recommended that a controlled clinical trial, ideally with rand om allocation to an intervention and control group, be conducted. Long-term survival rates need to be a primary aim of such a trial.