Dataset Information

Efficacy and safety of laparo-endoscopic resections of colorectal neoplasia: A systematic review.

ABSTRACT:

Objective

The purpose of this review is to assess the efficacy and safety of laparo-endoscopic local resections for colorectal lesions not suitable for endoscopic resection.

Summary background data

The combined laparo-endoscopic approach has been proposed for large colorectal lesions unsuitable for endoscopic resection, in order to reduce morbidity of common laparoscopic resection. However, data on the efficacy and safety of laparo-endoscopic local resections are still controversial.

Methods

An Embase search of papers published during the period 1985-2014 was performed. Published studies that evaluated laparo-endoscopic resections for colorectal lesions were assessed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) recommendations by two authors. Forest plots on primary (per-lesion rate of further surgery, including surgery for complications and surgery for oncologic radical treatment) and secondary outcomes were produced based on fixed and random effects models. Heterogeneity was assessed using the I (2) statistic. Risk for within-study bias was ascertained with QUADAS (Quality Assessment of Diagnostic Accuracy Studies) system.

Results

A total of 11 studies provided data on 707 lesions treated with a combined laparo-endoscopic approach. A variety of techniques were reported. The overall per-lesion rate of further surgery was 9.5%, while per-lesion rate of further surgery for oncologic treatment was 7.9%, per-lesion rate of further surgery for complications treatment was 3.5%, incidence of adenocarcinoma was 10.5%, incidence of overall complications was 7.9%, incidence of conversion to open surgery 4.3% and incidence of recurrence was 5.4%.

Conclusions

Despite laparo-endoscopic approach ensures limited invasiveness, it is affected by a consistent rate of complications and oncologic inadequacy that often requires further surgical treatment.

SUBMITTER: Arezzo A

PROVIDER: S-EPMC4669514 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Efficacy and safety of laparo-endoscopic resections of colorectal neoplasia: A systematic review.

Arezzo Alberto A Passera Roberto R Migliore Marco M Cirocchi Roberto R Galloro Giuseppe G Manta Raffaele R Morino Mario M

United European gastroenterology journal 20151201 6

<h4>Objective</h4>The purpose of this review is to assess the efficacy and safety of laparo-endoscopic local resections for colorectal lesions not suitable for endoscopic resection.<h4>Summary background data</h4>The combined laparo-endoscopic approach has been proposed for large colorectal lesions unsuitable for endoscopic resection, in order to reduce morbidity of common laparoscopic resection. However, data on the efficacy and safety of laparo-endoscopic local resections are still controversi ...[more]

PMID: 26668744

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Project description:BackgroundThere are still clinical controversy on the efficacy and safety of endoscopic resection (ER) and laparoscopic resection (LR) in the treatment of gastrointestinal stromal tumors (GISTs). The present study aimed to evaluate the safety and efficacy of ER in the treatment of GISTs by comparing the relative outcomes of ER to LR.MethodsPubMed, Web of Science, Cochrane Library, and Embase were searched. Data were retrieved from January 2010 to January 2020 and subjected to a meta-analysis based on the intraoperative and postoperative outcomes of ER and LR. The intervention arm was treated by LR while the comparator arm was treated by ER. Relevant literature was selected based on the inclusion criteria, data was extracted, and quality evaluation of the included literature was carried out. The Newcastle-Ottawa Scale (NOS) was applied for assessing the quality of included studies. Heterogeneity between studies was assessed using the Cochrane χ2 test and I2 statistic, and Funnel plots and Egger's test were used to detect publication bias.ResultsThe present analysis included 13 studies, comprising a total of 1,261 patients, (ER vs. LR: 543 vs. 718). The incidence rate of postoperative complications [odds ratio (OR), 0.400; P=0.001] was significantly lower in the ER group [3.3%; 95% confidence interval (CI), 0.015 to 0.055] than the LR group (8.9%; 95% CI, 0.03 to 0.17). The meta-analysis revealed that the recurrence rate following ER (1.7%; 95% CI, 0.005 to 0.033) was lower than that following LR (2.5%; 95% CI, 0.012 to 0.041). The R0 resection rate of ER (99%; 95% CI, 0.975 to 0.999) was similar to that of LR (100%; 95% CI, 0.995 to 1.000). No publication bias in this study (P>0.10), and the sensitivity analysis showed that the study was robust.ConclusionsER was safer and more efficient than LR in terms of all the outcomes, except the R0 resection rate. Thus, ER should be considered the treatment of choice. However, attention should be paid to the surgical margin status following ER.

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Dataset Information

Efficacy and safety of laparo-endoscopic resections of colorectal neoplasia: A systematic review.

Objective

Summary background data

Methods

Results

Conclusions

Publications

Efficacy and safety of laparo-endoscopic resections of colorectal neoplasia: A systematic review.

Similar Datasets

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