Systematic review of laparoscopic versus open surgery for colorectal cancer (Br J Surg 2006; 93: 921–928)

Sir Reza et al. performed another systematic review to compare outcomes after laparoscopic or open surgery for colorectal cancer. Although it cannot be questioned that randomized clinical studies and systematic reviews are valuable to interpret and facilitate implementation of evidence, it is surprising that they continue to be published based upon randomized trials with insufficient methodology regarding early outcomes. In particular, it makes little sense to continue to accumulate data from these studies where evidence-based principles of care have not been described or implemented. Laparoscopic surgeons have adjusted their care principles (nasogastric tubes, feeding, etc.) to current evidence, but have not done the same in patients who had an open procedure, thereby introducing bias in their early outcome results1. The evidence-based principles of fast-track surgery (for open and laparoscopic surgery) have led to greater short-term benefits than have been achieved by the laparoscopic approach alone2. It is to be hoped that future studies will include a better design to compare laparoscopic and open surgery and that surgeons will realise that postoperative outcome is determined by several factors which have to be controlled and adjusted to available scientific evidence when doing single-interventional randomized trials.