Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years?

R Shearer, M Gale, O E Aly, E H Aly

Research output: Contribution to journalReview article

21 Citations (Scopus)

Abstract

AIM: Laparoscopic rectal cancer surgery has been increasingly used since 1991 following the publication of the first case series. Since then, several studies have confirmed that laparoscopic surgery for rectal cancer is challenging with associated morbidity and mortality. The aim of this study was to determine if the rates of early postoperative complications in laparoscopic rectal cancer surgery have improved over the past 20 years.

METHOD: A literature search of the EMBASE and MEDLINE databases between August 1991 and August 2011 was conducted using the keywords laparoscopy, rectal cancer and postoperative complications. Data were analysed using linear regression ANOVA performed in GNUMERICS software.

RESULTS: Ninety-seven studies were included for analysis. Over the last 20 years there has been no significant change in the rate of any early postoperative complications (anastomotic leak, conversion, sexual, urinary or faecal dysfunction, wound infection, overall morbidity or mortality). However, in the last 3 years, the rate of positive resection margins has decreased significantly (P = 0.01).

CONCLUSION: There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.

Original languageEnglish
Pages (from-to)1211-1226
Number of pages16
JournalColorectal Disease
Volume15
Issue number10
Early online date24 Oct 2013
DOIs
Publication statusPublished - Oct 2013

Fingerprint

Rectal Neoplasms
Morbidity
Laparoscopy
Publications
Anastomotic Leak
Learning Curve
Mortality
Wound Infection
MEDLINE
Linear Models
Analysis of Variance
Software
Randomized Controlled Trials
Databases

Keywords

  • Rectal surgery
  • laparoscopic
  • complications

Cite this

Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years? / Shearer, R; Gale, M; Aly, O E; Aly, E H.

In: Colorectal Disease, Vol. 15, No. 10, 10.2013, p. 1211-1226.

Research output: Contribution to journalReview article

@article{cff8a3b5dad14b60b93c3140071949cf,
title = "Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years?",
abstract = "AIM: Laparoscopic rectal cancer surgery has been increasingly used since 1991 following the publication of the first case series. Since then, several studies have confirmed that laparoscopic surgery for rectal cancer is challenging with associated morbidity and mortality. The aim of this study was to determine if the rates of early postoperative complications in laparoscopic rectal cancer surgery have improved over the past 20 years.METHOD: A literature search of the EMBASE and MEDLINE databases between August 1991 and August 2011 was conducted using the keywords laparoscopy, rectal cancer and postoperative complications. Data were analysed using linear regression ANOVA performed in GNUMERICS software.RESULTS: Ninety-seven studies were included for analysis. Over the last 20 years there has been no significant change in the rate of any early postoperative complications (anastomotic leak, conversion, sexual, urinary or faecal dysfunction, wound infection, overall morbidity or mortality). However, in the last 3 years, the rate of positive resection margins has decreased significantly (P = 0.01).CONCLUSION: There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.",
keywords = "Rectal surgery, laparoscopic, complications",
author = "R Shearer and M Gale and Aly, {O E} and Aly, {E H}",
note = "Colorectal Disease {\circledC} 2013 The Association of Coloproctology of Great Britain and Ireland.",
year = "2013",
month = "10",
doi = "10.1111/codi.12302",
language = "English",
volume = "15",
pages = "1211--1226",
journal = "Colorectal Disease",
issn = "1462-8910",
publisher = "WILEY-BLACKWELL",
number = "10",

}

TY - JOUR

T1 - Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years?

AU - Shearer, R

AU - Gale, M

AU - Aly, O E

AU - Aly, E H

N1 - Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

PY - 2013/10

Y1 - 2013/10

N2 - AIM: Laparoscopic rectal cancer surgery has been increasingly used since 1991 following the publication of the first case series. Since then, several studies have confirmed that laparoscopic surgery for rectal cancer is challenging with associated morbidity and mortality. The aim of this study was to determine if the rates of early postoperative complications in laparoscopic rectal cancer surgery have improved over the past 20 years.METHOD: A literature search of the EMBASE and MEDLINE databases between August 1991 and August 2011 was conducted using the keywords laparoscopy, rectal cancer and postoperative complications. Data were analysed using linear regression ANOVA performed in GNUMERICS software.RESULTS: Ninety-seven studies were included for analysis. Over the last 20 years there has been no significant change in the rate of any early postoperative complications (anastomotic leak, conversion, sexual, urinary or faecal dysfunction, wound infection, overall morbidity or mortality). However, in the last 3 years, the rate of positive resection margins has decreased significantly (P = 0.01).CONCLUSION: There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.

AB - AIM: Laparoscopic rectal cancer surgery has been increasingly used since 1991 following the publication of the first case series. Since then, several studies have confirmed that laparoscopic surgery for rectal cancer is challenging with associated morbidity and mortality. The aim of this study was to determine if the rates of early postoperative complications in laparoscopic rectal cancer surgery have improved over the past 20 years.METHOD: A literature search of the EMBASE and MEDLINE databases between August 1991 and August 2011 was conducted using the keywords laparoscopy, rectal cancer and postoperative complications. Data were analysed using linear regression ANOVA performed in GNUMERICS software.RESULTS: Ninety-seven studies were included for analysis. Over the last 20 years there has been no significant change in the rate of any early postoperative complications (anastomotic leak, conversion, sexual, urinary or faecal dysfunction, wound infection, overall morbidity or mortality). However, in the last 3 years, the rate of positive resection margins has decreased significantly (P = 0.01).CONCLUSION: There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.

KW - Rectal surgery

KW - laparoscopic

KW - complications

U2 - 10.1111/codi.12302

DO - 10.1111/codi.12302

M3 - Review article

VL - 15

SP - 1211

EP - 1226

JO - Colorectal Disease

JF - Colorectal Disease

SN - 1462-8910

IS - 10

ER -