Colorectal resections are common surgical procedures all over the world.
Laparoscopic colorectal surgery is technically feasible in a considerable amount of patients under elective conditions.
Several short-term benefits of the laparoscopic approach to colorectal resection have been proposed.
The short-term benefits include less pain, less morbidity, improved reconvalescence and better quality of life.
Dr Schwenk conducted a review to compare laparoscopic and conventional colorectal resection.
The researchers considered the possible benefits of the laparoscopic method in the short-term postoperative period, up to 3 months post surgery.
The research team searched MEDLINE, EMBASE, CancerLit, and the Cochrane Central Register of Controlled Trials from1991 to 2004.
|Intraoperative blood was less and operative time was longer in laparoscopic surgery|
|The Cochrane Library|
The team handsearched various surgery journals from 1991 to 2004, as well as abstracts from the society meetings.
All randomised-controlled trial were included regardless of the language of publication.
Results from papers were extracted independently by 3 observers on a predefined data sheet, solving disagreements by discussion.
'REVMAN 4.2' was used for statistical analysis, and the mean differences were used for analysing continuous variables.
If studies reported medians and ranges instead of means and standard deviations, the team assumed the difference of medians to be equal to the difference of means.
If no measure of dispersion was given, the researchers tried to obtain these data from the authors or estimated standard deviation as the mean or median.
Data were pooled and the team calculated weighted mean differences with their 95% confidence using random effects models.
The researchers included and analysed 25 randomised controlled trials.
Methodological quality of most of these trials was only moderate and perioperative treatment was very traditional in most studies.
The team found that operative time was longer in laparoscopic surgery, but intraoperative blood was less than in conventional surgery.
The researchers observed that intensity of postoperative pain and duration of postoperative ileus was shorter after laparoscopic colorectal resection.
Pulmonary function was improved after a laparoscopic approach.
The team noted that total morbidity and surgical morbidity was decreased in the laparoscopic groups.
General morbidity and mortality was not different between both groups, and until the 30th postoperative day, quality of life was better in laparoscopic patients.
In addition, the team noted that postoperative hospital stay was less in laparoscopic patients.
Dr Schwenk's team concludes, "Under traditional perioperative treatment, lapararoscopic colonic resections show clinically relevant advantages in selected patients.”
“If the long-term oncological results of laparoscopic and conventional resection of colonic carcinoma show equivalent results, the laparoscopic approach should be preferred in patients suitable for this approach to colectomy.”