Advantages and disadvantages of laparoscopic access for pelvic exenteration in patients with locally advanced rectal cancer (a meta-analysis and a systematic review)

AIM: pelvic exenteration is a surgical procedure for locally advanced pelvic organ cancer in order to achieve optimal resection margins. The expediency of performing such operations with laparoscopic access is controversial. A meta-analysis was done to evaluate the effectiveness of laparoscopic pelvic exenterations for rectal cancer. MATERIALS AND METHODS: a systematic review was conducted in accordance with PRISMA practices and recommendations. Literature search was carried out in the electronic medical literature databases PubMed and eLibrary. According to a meta-analysis of 4 original studies, the results of treatment of 220 patients who underwent laparoscopic exenteration and 311 patients who underwent open surgery were evaluated. RESULTS: significant differences were obtained in the reduction of intraoperative blood loss by 427 ml, 95% CI, p = 0.0004, and postoperative hospital stay by 2 days, 95% CI, p = 0.003 in the laparoscopic group. Comparable data were obtained for the operation time, p = 0.45, for the positive margin of resection (OR 0.85; 95% CI 0.19–3.93; p = 0.84), for the postoperative morbidity (OR 0.62; 95% CI 0.23–1.86; p = 0.34) and for surgical site infections (OR 0.56; 95% CI 0.18–1.64; p = 0.29). CONCLUSION: laparoscopic exenterations are comparable in operation time to open procedure, reduce intraoperative blood loss and postoperative hospital stay days.