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A Meta-analysis

Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group^*

Arch Surg. 2007;142(3):298-303.

Objective  To perform a meta-analysis of trials randomizing patients with colon cancer to laparoscopically assisted or open colectomy to enhance the power in determining whether laparoscopic colectomy for cancer is oncologically safe.

Data Sources  The databases of the Barcelona, Clinical Outcomes of Surgical Therapy (COST), Colon Cancer Laparoscopic or Open Resection (COLOR), and Conventional vs Laparoscopic-Assisted Surgery in Patients With Colorectal Cancer (CLASICC) trials were the data sources for the study.

Study Selection  Patients who had at least 3 years of complete follow-up data were selected.

Data Extraction  Patients who had undergone curative surgery before March 1, 2000, were studied. Three-year disease-free survival and overall survival were the primary outcomes of this analysis.

Data Synthesis  Of 1765 patients, 229 were excluded, leaving 796 patients in the laparoscopically assisted arm and 740 patients in the open arm for analysis. Three-year disease-free survival rates in the laparoscopically assisted and open arms were 75.8% and 75.3%, respectively (95% confidence interval [CI] of the difference, –5% to 4%). The associated common hazard ratio (laparoscopically assisted vs open surgery with adjustment for sex, age, and stage) was 0.99 (95% CI, 0.80-1.22; P = .92). The 3-year overall survival rate after laparoscopic surgery was 82.2% and after open surgery was 83.5% (95% CI of the difference, –3% to 5%). The associated hazard ratio was 1.07 (95% CI, 0.83-1.37; P = .61). Disease-free and overall survival rates for stages I, II, and III evaluated separately did not differ between the 2 treatments.

Conclusion  Laparoscopically assisted colectomy for cancer is oncologically safe.

*Authors/Writing Committee: The following individuals constitute the Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group and take authorship responsibility for the study: H. Jacob Bonjer, MD; Wim C. J. Hop, PhD; Heidi Nelson, MD; Daniel J. Sargent, PhD; Antonio M. Lacy, MD; Antoni Castells, MD; Pierre J. Guillou, MD; Helen Thorpe, MSc; Julia Brown, MSc; Salvadora Delgado, MD; Esther Kuhrij, MD; Eva Haglind, MD; Lars Påhlman, MD.
Author Affiliations:Departments of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands (Drs Bonjer, Hop, and Kuhrij), Mayo Clinic, Rochester, Minn (Drs Nelson and Sargent), Hospital Clinic, University of Barcelona, Barcelona, Spain (Drs Lacy, Castells, and Delgado), University of Leeds, Leeds, England (Dr Guillou and Mss Thorpe and Brown), Goteborg University, Goteborg, Sweden (Dr Haglind), and University of Uppsala, Uppsala, Sweden (Dr Påhlman). Dr Bonjer is now with the Department of Surgery, Dalhousie University, and Capital Health, Halifax, Nova Scotia.

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