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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Five-year long-term outcomes of laparoscopic surgery for colon cancer

HL Bai, B Chen, Y Zhou, and XT Wu.

Review published: 2010.

CRD summary

The authors concluded that laparoscopic surgery was as efficacious and safe as open surgery in the treatment of colon cancer. The reliability of the conclusions is uncertain given a number of weaknesses in the review processes including the potential for publication bias, high risk of reviewer error and bias, and incomplete reporting of trial details.

Authors' objectives

To compare the effects of laparoscopic-assisted surgery versus open surgery on long-term recurrence rates.

Searching

MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Search terms were reported. Reference lists of identified articles were handsearched.

Study selection

Prospective randomised controlled trials (RCTs) that compared the effects of laparoscopic surgery versus open surgery in patients with colon cancer were eligible for inclusion. Trials had to enrol more than 100 patients and follow-up patients for more than five years to be considered. Outcome measures were overall mortality and recurrence of cancer.

Settings were not reported for included trials. The median age of included patients ranged from 68 to 71 years.

The authors did not state how the studies were selected studies for inclusion.

Assessment of study quality

Two authors independently assessed trial quality based on the method of randomisation, allocation concealment, blinding of outcome assessors, use of an intention-to-treat analysis, and withdrawals and drop-outs. Trial quality was ranked as good (if three or more quality domains were reported), moderate (if one or two quality domains were reported), or low (if none of the quality domains were reported).

Data extraction

Data for calculating risk ratios (RRs) and 95% confidence intervals (CIs) were extracted. The authors did not state how many reviewers performed data extraction.

Methods of synthesis

Pooled risk ratios and 95% confidence intervals were calculated using fixed-effect model (inverse variance method) where there was no evidence of heterogeneity; otherwise random-effects model (DerSimonian-Laird method) was used. Heterogeneity was assessed using X2 and I2. Publication bias was assessed visually using funnel plots.

Results of the review

Three RCTs were included (n=2,158 patients, range 863 to 1,076). Random allocation, intention-to-treat analysis and withdrawals and drop-outs were report in all the trials. Concealment of allocation was reported as adequate in one trial. Blinding was reported as unclear in all the trials. Follow-up periods ranged from 53 months to 95 months.

There was no significant difference in mortality or the development of overall recurrence between laparoscopic and open surgery groups.

Authors' conclusions

The findings suggested that laparoscopic surgery was as efficacious and safe as open surgery in the treatment of colon cancer.

CRD commentary

The review question was clearly stated. Three relevant databases were searched. Limited efforts were made to search for unpublished studies, so some relevant studies may have been missed. Steps were taken to minimise reviewer error and bias in study quality assessment, but not explicitly with study selection and data extraction.

Trial quality was assessed and results reported. The methods used to combine data and account for statistical heterogeneity were appropriate and justified. Limited details about included trials were reported. Few trials with large sample sizes were included. No evidence was provided for inferences on costs and cost-effectiveness of treatments.

Given a number of weaknesses (potential for publication bias, high risk of reviewer error and bias, incomplete reporting of trial details) the reliability of the authors' conclusion is uncertain.

Implications of the review for practice and research

Practice: The authors stated that based on the current findings, laparoscopic assisted colectomy should be the preferred treatment for colon adenocarcinoma.

Research: The authors did not state any implications for further research.

Funding

Not stated.

Bibliographic details

Bai HL, Chen B, Zhou Y, Wu XT. Five-year long-term outcomes of laparoscopic surgery for colon cancer. World Journal of Gastroenterology 2010; 16(39): 4992-4997. [PMC free article: PMC2957610] [PubMed: 20954288]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adenocarcinoma /mortality /surgery; Chi-Square Distribution; China; Colectomy /adverse effects /methods /mortality; Colonic Neoplasms /mortality /surgery; Disease-Free Survival; Evidence-Based Medicine; Humans; Laparoscopy /adverse effects /mortality; Odds Ratio; Patient Selection; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

AccessionNumber

12010007831

Database entry date

27/07/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20954288

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