TY - JOUR
T1 - Laparoscopic versus open colorectal surgery in the emergency setting
T2 - A systematic review and meta-analysis
AU - Warps, Anne-Loes K.
AU - Zwanenburg, Emma S.
AU - Dekker, Jan Willem T.
AU - Tollenaar, Rob A. E. M.
AU - Bemelman, Willem A.
AU - Hompes, Roel
AU - Tanis, Pieter J.
AU - de Groof, Elisabeth J.
N1 - Funding Information: The initial literature search identified a total of 2841 studies. One additional study was found by hand-searching reference lists. After the removal of duplicates, 1773 studies remained for title and abstract screening. Eventually, 61 studies were assessed for eligibility based on full text, of which 29 studies were eligible, including 1 feasibility RCT and 28 retrospective cohort studies, including several large population-based studies (). One study was funded by a company that financially supported the author, five studies received financial support or grants from the government, healthcare improvement programs, or foundations but declared no (financial) conflicts of interest, and seven studies provided no information on conflicts of interests or financial support. Characteristics of the included studies are presented in . Publisher Copyright: Copyright © 2021 The Author(s).
PY - 2021
Y1 - 2021
N2 - Objective: This systematic review and meta-analysis aimed to compare published outcomes of patients undergoing laparoscopic versus open emergency colorectal surgery, with mortality as primary outcome. Background: In contrast to the elective setting, the value of laparoscopic emergency colorectal surgery remains unclear. Methods: PubMed, Embase, the Cochrane Library, and CINAHL were searched until January 6, 2021. Only comparative studies were included. Meta-analyses were performed using a random-effect model. The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used for quality assessment. Results: Overall, 28 observational studies and 1 randomized controlled trial were included, comprising 7865 laparoscopy patients and 55,862 open surgery patients. Quality assessment revealed ‘good quality’ in 16 of 28 observational studies, and low to intermediate risk of bias for the randomized trial. Laparoscopy was associated with significantly lower postoperative mortality compared to open surgery (odds ratio [OR] 0.44; 95% confidence interval [CI], 0.35–0.54). Laparoscopy resulted in significantly less postoperative overall morbidity (OR, 0.53; 95% CI, 0.43–0.65), wound infection (OR, 0.63; 95% CI, 0.45–0.88), wound dehiscence (OR, 0.37; 95% CI, 0.18–0.77), ileus (OR, 0.68; 95% CI 0.51–0.91), pulmonary (OR, 0.43; 95% CI, 0.24–0.78) and cardiac complications (OR, 0.56; 95% CI, 0.35–0.90), and shorter length of stay. No meta-analyses were performed for long-term outcomes due to scarcity of data. Conclusions: The systematic review and meta-analysis suggest a benefit of laparoscopy for emergency colorectal surgery, with a lower risk of postoperative mortality and morbidity. However, the almost exclusive use of retrospective observational study designs with inherent biases should be taken into account.
AB - Objective: This systematic review and meta-analysis aimed to compare published outcomes of patients undergoing laparoscopic versus open emergency colorectal surgery, with mortality as primary outcome. Background: In contrast to the elective setting, the value of laparoscopic emergency colorectal surgery remains unclear. Methods: PubMed, Embase, the Cochrane Library, and CINAHL were searched until January 6, 2021. Only comparative studies were included. Meta-analyses were performed using a random-effect model. The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used for quality assessment. Results: Overall, 28 observational studies and 1 randomized controlled trial were included, comprising 7865 laparoscopy patients and 55,862 open surgery patients. Quality assessment revealed ‘good quality’ in 16 of 28 observational studies, and low to intermediate risk of bias for the randomized trial. Laparoscopy was associated with significantly lower postoperative mortality compared to open surgery (odds ratio [OR] 0.44; 95% confidence interval [CI], 0.35–0.54). Laparoscopy resulted in significantly less postoperative overall morbidity (OR, 0.53; 95% CI, 0.43–0.65), wound infection (OR, 0.63; 95% CI, 0.45–0.88), wound dehiscence (OR, 0.37; 95% CI, 0.18–0.77), ileus (OR, 0.68; 95% CI 0.51–0.91), pulmonary (OR, 0.43; 95% CI, 0.24–0.78) and cardiac complications (OR, 0.56; 95% CI, 0.35–0.90), and shorter length of stay. No meta-analyses were performed for long-term outcomes due to scarcity of data. Conclusions: The systematic review and meta-analysis suggest a benefit of laparoscopy for emergency colorectal surgery, with a lower risk of postoperative mortality and morbidity. However, the almost exclusive use of retrospective observational study designs with inherent biases should be taken into account.
UR - http://www.scopus.com/inward/record.url?scp=85118120249&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/AS9.0000000000000097
DO - https://doi.org/10.1097/AS9.0000000000000097
M3 - Article
SN - 0003-4932
JO - Annals of surgery
JF - Annals of surgery
M1 - e097
ER -