Which surgical approach is best for management of rectal cancer? Does the end point tell how it ends ?
A partir d'une revue systématique de la littérature publiée entre 1995 et 2016 (14 essais incluant au total 4 034 patients atteints d'un cancer colorectal), cette méta-analyse compare, du point de vue du taux de marges de résection circonférentielles positives et de la qualité de la résection, l'efficacité de deux techniques d'exérèse mésorectale, l'une par voie ouverte, l'autre par voie laparoscopique
In this issue of JAMA Surgery, Martínez-Pérez and colleagues3 present the timely results of a meta-analysis of 14 randomized clinical trials comparing laparoscopy with open surgery for rectal cancer. They focus exclusively on pathologic outcomes. The positive CRM rate for laparoscopy was 7.9% vs 6.1% for open surgery (relative risk ,1.17; 95% CI, 0.89-1.53, P=.26; I2=0%, 9 studies). Laparoscopic procedures were associated with a higher rate of noncomplete mesorectal excision (13.2% vs 10.4%; relative risk, 1.31; 95% CI, 1.05-1.64; P=.02; I2=0%, 5 studies). The authors conclude that these findings should lessen the enthusiasm for a laparoscopic approach to rectal cancer.
JAMA Surgery , commentaire, 2016