Summary of findings:

Laparoscopic assisted colorectal resection compared to open method for patients with colon and rectosigmoid carcinoma (Tjandra 2006)

Patient or population: patients with colon and rectosigmoid carcinoma

Setting: hospital

Intervention: laparoscopic assisted colorectal resection

Comparison: open method

Outcomes

Anticipated absolute effects^* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with open method

Risk with laparoscopic assisted colorectal resection

Mortality

20 per 1.000

7 per 1.000
(3 to 15)

OR 0.33
(0.16 to 0.72)

3764
(12 RCTs)

⨁⨁⨁◯
MODERATE ^a

Laparoscopic resection would probably result in a lower mortality compared to an open method of surgery.

Post operative complications (overall)

226 per 1.000

178 per 1.000
(139 to 226)

OR 0.74
(0.55 to 1.00)

3898
(15 RCTs)

⨁⨁◯◯
LOW ^a,b

overall complication rate: the total number of patients with complication; wound complications: wound infection and dehiscence; all-surgical complications: surgery related complications excluding medical problems

Laparoscopic resection might possibly lower the odds for overall post-operative complications compared to an open surgery method.

Post operative complications (wound complications)

∞ per 1.000

OR 0.65
(-- to --)

(11 RCTs)

⨁⨁⨁◯
MODERATE ^a

Total sample size and 95% confidence intervals not reported (significant relative effect: p=0.01)

Laparoscipic resection could probably result in lower odds for wound complications when compared to an open surgery method.

Post operative complications (all surgical complications)

∞ per 1.000

OR 0.75
(-- to --)

(13 RCTs)

⨁⨁◯◯
LOW ^a,b

Total sample size and 95% confidence intervals not reported (non-significant relative effect: p=0.19)

Laparoscopic resection might possibly lower the odds for surgical complications compared to an open surgery method.

Post operative recovery - not reported

-

-

-

-

-

Long term morbidity - not reported

-

-

-

-

-

Long term survival - not reported

-

-

-

-

-

Extent of procedure (radicality) - not reported

-

-

-

-

-

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; OR: Odds ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Summary of findings:

Laparoscopic assisted colorectal resection compared to open method for patients with a locally advanced colon carcinoma (Feinberg 2017)

Patient or population: patients with a locally advanced colon carcinoma

Setting:

Intervention: laparoscopic assisted colorectal resection

Comparison: open method

Outcomes

Anticipated absolute effects^* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with open method

Risk with laparoscopic assisted colorectal resection

Overall survival

A pooled hazard ratio of 1.28 (95%CI: 0.94-1.72) was reported. The number of events were not shown in the forrest plot for the laparoscopic group (n=215) and the open group (n=176).

391
(3 observational studies)

⨁◯◯◯
VERY LOW ^a,b

Favoring open procedure. Median follow-up: 3 years to >5 years

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the overall survival compared to an open surgery method.

Disease-free survival

A pooled hazard ratio of 1.20 (95%CI: 0.90-1.61) was reported. The number of events were not shown in the forrest plot for the laparoscopic group (n=220) and the open group (n=187).

407
(4 observational studies)

⨁◯◯◯
VERY LOW ^a,b

Favoring open procedure. Median follow-up: 3 years to 11.5 years (one study only stated a follow-up of >5 years)

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the disease-free survival compared to an open surgery method.

Extent of the procedure (radicality: positive resection margin)

A pooled odds ratio of 1.16 (95%CI: 0.58-2.32) was reported. The number of events were not shown in the forest plot for the laparoscopic group (n=586) and the open group (n=498).

1084
(3 observational studies)

⨁◯◯◯
VERY LOW ^a,c

Favoring open procedure. Median follow-up: 3 years to 11.5 years

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the radicality (positive resection margin) compared to an open surgery method.

Extent of the procedure (radicality: number of harvested lymphnodes)

The mean extent of the procedure (radicality: number of harvested lymphnodes) in the intervention group was 2,26 Lymph nodes more (0,58 more to 3,93 more)

-

407
(4 observational studies)

⨁◯◯◯
VERY LOW ^a

There were more lymph nodes harvested with the laparoscopic procedure.

Observational studies start out at a ‘Low’grade.

We are unsure of the effects of laparoscopic resection on the radicality (number of harvested lymph nodes) compared to an open surgery method.

Post operative recovery - not reported

-

-

-

-

-

post operative complications - not reported

-

-

-

-

-

Post operative mortality - not reported

-

-

-

-

-

Long term morbidity - not reported

-

-

-

-

-

Long term survival - not reported

-

-

-

-

-

Costs - not reported

-

-

-

-

-

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; HR: Hazard Ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Summary of findings:

Laparoscopic assisted colorectal resection compared to open method for patients undoergoing colonic surgery within a fast-track programme (Vlug 2009)

Patient or population: patients undoergoing colonic surgery within a fast-track programme

Setting:

Intervention: laparoscopic assisted colorectal resection

Comparison: open method

Outcomes

Anticipated absolute effects^* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with open method

Risk with laparoscopic assisted colorectal resection

Morbidity
follow-up: range 30 days to 3 months

The number needed to treat (95%CI) as reported in the systematic review from the included studies: -17.3 (-3.6-6.1) / -15.0 (-3.5-6.8) / -12.5 (-3.2-6.5) / 4.4 (2.6-15.9) / 8.5 (-9.2-2.9). The absolute risk reduction (95%CI) as reported in the systematic review from the included studies: -0.080 (-0.313-0.154) / -0.067 (-0.280-0.147) / -0.058 (-0.279-0.164) / 0.117 (-0.019-0.342) / -0.227 (0.063-0.391).

400
(5 observational studies) ^a

⨁◯◯◯
VERY LOW ^b,c

Reported estimates did not seem to match with the reported confidence intervals in some instances. Individual patient data was not pooled in a meta-analysis.

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the morbidity (range: 30 days – 3 months) compared to an open surgery method.

Mortality
follow-up: range 30 days to 3 months

The number needed to treat (95%CI) as reported in the systematic review from the included studies: -33.2 (-7.9-14.9) / 10 (-142.9-4.8) / 35.5 (-12-7.2). The absolute risk reduction (95%CI) as reported in the systematic review from the included studies: -0.030 (-0.127-0.067) / 0.028 (-0.083-0.139) / 0.100 (-0.007-0.207).

198
(3 observational studies) ^d

⨁◯◯◯
VERY LOW ^b,c

Reported estimates did not seem to match with the reported confidence intervals in some instances. Individual patient data was not pooled in a meta-analysis.

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the mortality (range: 30 days – 3 months) compared to an open surgery method.

Post operative recovery - not reported

-

-

-

-

-

Post operative complications - not reported

-

-

-

-

-

Extent of the procedure (radicality) - not reported

-

-

-

-

-

Long term morbidity - not reported

-

-

-

-

-

Long term survival - not reported

-

-

-

-

-

Costs - not reported

-

-

-

-

-

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Summary of findings:

Laparoscopic assisted colorectal resection compared to open method for patients with colon cancer of the splenic flexure (Martínez-Pérez 2017)

Patient or population: patients with colon cancer of the splenic flexure

Setting:

Intervention: laparoscopic assisted colorectal resection

Comparison: open method

Outcomes

Anticipated absolute effects^* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with open method

Risk with laparoscopic assisted colorectal resection

Post operative complications

261 per 1.000

435 per 1.000
(273 to 614)

OR 2.18
(1.06 to 4.49)

240
(3 observational studies)

⨁◯◯◯
VERY LOW ^a,b

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the post-operative complications compared to an open surgery method for patients with colon cancer of the splenic flexure.

Extent of the procedure (radicality: number of lymph nodes harvested)

Results were contradictive from the only two studies reporting the retrieval of lymph nodes, where in the laparoscopic procedure 16 (range: 8-32) and 13.8 (SD: 8.8) lymph nodes were harvested while in the open procedure 12 (range: 4-29) and 15.9 (SD: 10.7) lymph nodes were harvested, respectively.

144
(2 observational studies)

⨁◯◯◯
VERY LOW ^a,c

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the radicality (number of lymph nodes harvested) compared to an open surgery method for patients with colon cancer of the splenic flexure.

Long term survival (5-year overall survival)

One study in the systematic review reported the 5-year overall survival. For patients with stage II tumours in the laparoscopy group (n=28) the survival was 94.6% compared to 85.6% in the open group (n=15). The survival for patients with stage III tumours was 73.5% in the laparoscopic group (n=33) compared to 66.2% in the open group (n=19). No differences between survival rates were found (no p-value reported).

95
(1 observational study)

⨁◯◯◯
VERY LOW ^a,d

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the long-term (5-year) overall survival compared to an open surgery method for patients with colon cancer of the splenic flexure.

Long term survival (5-year disease-free survival)

One study in the systematic review reported the 5-year disease-free survival. For patients with stage II tumours in the laparoscopy group (n=28) the survival was 91.1% compared to 85.6% in the open group (n=15). The survival for patients with stage III tumours was 60.3% in the laparoscopic group (n=33) compared to 56.7% in the open group (n=19). No differences between survival rates were found (no p-value reported).

95
(1 observational study)

⨁◯◯◯
VERY LOW ^a,d

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the long-term (5-year) disease-free survival compared to an open surgery method for patients with colon cancer of the splenic flexure.

Post operative recovery - not reported

-

-

-

-

-

Post operative mortality - not reported

-

-

-

-

-

Long term morbidity - not reported

-

-

-

-

-

Costs - not reported

-

-

-

-

-

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; OR: Odds ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Summary of findings:

Laparoscopic assisted resection compared to open method for patients with intestinal obstruction due to right colon cancer (Cirocchi 2017)

Patient or population: patients with intestinal obstruction due to right colon cancer

Setting:

Intervention: laparoscopic assisted resection

Comparison: open method

Outcomes

Anticipated absolute effects^* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with open method

Risk with laparoscopic assisted resection

Post operative complications (overall 30-day complications)

574 per 1.000

229 per 1.000
(86 to 475)

OR 0.22
(0.07 to 0.67)

78
(2 observational studies)

⨁◯◯◯
VERY LOW ^a,b

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the overall 30-day complications compared to an open surgery method for patients with intestinal obstruction due to right colon cancer.

Morbidity (anastomosis leakage)

63 per 1.000

49 per 1.000
(2 to 580)

OR 0.78
(0.03 to 20.70)

54
(2 observational studies)

⨁◯◯◯
VERY LOW ^a,b

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the anastomosis leakage rate compared to an open surgery method for patients with intestinal obstruction due to right colon cancer.

Costs

One study in the systematic review reported the costs of both procedures in US dollars. The laparoscopic procedure costed $12.360 (5.080-33.530) compared to an open procedure which costed $11.300 (6.590-40.920). No statistical significant differences between groups were found (p-value not reported). From the systematic review it is unclear what type of measure of central tendency and measure of dispersion was used to describe the costs.

46
(1 observational study)

⨁◯◯◯
VERY LOW ^a,b

Observational studies start out at a ‘Low’ grade.

We are unsure of the costs of laparoscopic resection compared to the costs of an open surgery method for patients with intestinal obstruction due to right colon cancer.

Post operative mortality (30-day)

Two studies (addressing right hemicolectomy) were pooled, resulting in an OR=0.67 (95%CI: 0.06-7.05, I^2: 0%, n=78), favoring laparoscopy. Thee other studies were not included in the meta-analyses, however their 30-day post operative mortality was reported; The first study had 3 events in the laparoscopic group (n=26) and 9 events in the open group (n=49), resulting in an RR=0.56 (95%CI: 0.166-1.91) favoring laparoscopy. The second and third study both had 1 event in the laparoscopic group (n=14 and n=11, respectively) and 2 events in the open group (n=14 and n=29, respectively). This results in an RR=0.50 (95%CI: 0.05-4.90) favoring a laparoscopic procedure in the second study and an RR=1.32 (95%CI: 0.13-13.12) favoring an open procedure in the third study.

199
(5 observational studies)

⨁◯◯◯
VERY LOW ^a,c

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the 30-day post-operative mortality compared to an open surgery method for patients with intestinal obstruction due to right colon cancer.

Extend of the procedure (radicality: number of lymph nodes harvested)

One study reported the mean number of lymph nodes dissected. In the laparoscopic procedure there were on average 15.3 (SD: 5.6) lymph nodes dissected, while this was 16 (SD: 6.3) lymph nodes in the open procedure group. No significant differences were found between groups (p-value not reported).

35
(1 observational study)

⨁◯◯◯
VERY LOW ^a,b

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the radicality (number of lymph nodes harvested) compared to an open surgery method for patients with intestinal obstruction due to right colon cancer.

Long term survival (5-year overall survival)

No significant differences were found in one study describing the overall survival at 5 years. It is unclear which of the included studies reported the 5-year survival. No hazard ratios or p-values were reported.

(1 observational study)

⨁◯◯◯
VERY LOW ^a,b

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of laparoscopic resection on the long-term (5-year) overall survival compared to an open surgery method for patients with intestinal obstruction due to right colon cancer.

Post operative recovery - not reported

-

-

-

-

-

Long term morbidity - not reported

-

-

-

-

-

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; OR: Odds ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Summary of findings:

Single-incision compared to conventional multi-port for resection of colon carcinomas (Brockhaus 2016)

Patient or population: resection of colon carcinomas

Setting:

Intervention: single-incision

Comparison: conventional multi-port

Outcomes

Anticipated absolute effects^* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with conventional multi-port

Risk with single-incision

Complications (intra-operative and post-operative)

146 per 1.000

76 per 1.000
(20 to 284)

RR 0.52
(0.14 to 1.94)

82
(2 RCTs)

⨁◯◯◯
VERY LOW ^a,b

We are unsure of the effects of single incision on (intra and post)-operative complications compared to conventional multiport incision.

post-operative mortality (<30 days)

In both included RCTs there was no mortality in the intervention group or in the control group 30-days post-operatively.

82
(2 RCTs)

⨁⨁⨁◯
MODERATE ^c,d

Single incision would probably not increase or reduce post-operative mortality (<30 days) compared to multi-port incision.

Post-operative recovery (Length of Hospital stay)

The mean post-operative recovery (Length of Hospital stay) was 0 days

The mean post-operative recovery (Length of Hospital stay) in the intervention group was 1,2 days fewer (1,95 fewer to 0,44 fewer)

-

82
(2 RCTs)

⨁◯◯◯
VERY LOW ^a,d,e

Hospital stay was 1.2 days (95%CI: 1.95-0.44) days fewer for single incision.

We are unsure of the effects of single incision on the length of hospital stay compared to conventional multiport incision.

Extent of the procedure (number of lymph nodes harvested)

Huscher 2012 found a mean difference of 2.00 (95%CI: -1.83-5.83) lymph nodes more for single-incision. Poon 2012 found a mean difference of -4.62 (95%CI: -8.97- -0.27), indicating that a mean of 4.62 lymph nodes less were harvested for single-incision compared to multi-port incision.

82
(2 RCTs)

⨁◯◯◯
VERY LOW ^a,d,f

We are unsure of the effects of single incision on the number of lymph nodes harvested compared to conventional multiport incision.

Long-term survival (survival)

Only 1 RCT in the systematic review reported the (disease free) survival. The systematic review stated that there was no significant difference found for disease-free survival (no HR or p-value provided in the systematic review).

32
(1 RCT)

⨁◯◯◯
VERY LOW ^a,d

We are unsure of the effects of single incision on long-term survival compared to conventional multiport incision.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; MD: Mean difference

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Summary of findings:

Intra-corporal anastomosis compared to extra-corporal anastomosis for laparocopic resection of colon carcinoma (Wu 2017)

Patient or population: laparoscopic resection of colon carcinoma

Setting:

Intervention: intra-corporal anastomosis

Comparison: extra-corporal anastomosis

Outcomes

Anticipated absolute effects^* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with extra-corporal anastomosis

Risk with intra-corporal anastomosis

Post-operative recovery (length of hospital stay)

The mean post-operative recovery (length of hospital stay) in the intervention group was 1,03 days fewer (1,57 fewer to 0,48 fewer)

-

1578
(13 observational studies) ^a

⨁◯◯◯
VERY LOW ^b,c,d,e

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of intra-corporal anastomosis on the length of hospital stay compared to extra-corporal anastomosis.

post-operative recovery (time to first flatus)

The mean post-operative recovery (time to first flatus) in the intervention group was 0,23 days fewer (1,57 fewer to 0,48 fewer)

-

938
(6 observational studies) ^a

⨁◯◯◯
VERY LOW ^b,e,f

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of intra-corporal anastomosis on the time to first flatus compared to extra-corporal anastomosis.

Post-operative recovery (time to first defecation)

The mean post-operative recovery (time to first defecation) in the intervention group was 0,65 days fewer (0,57 fewer to 0,02 more)

-

342
(5 observational studies) ^a

⨁◯◯◯
VERY LOW ^b,g,h

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of intra-corporal anastomosis on the time to first defecation compared to extra-corporal anastomosis.

Post-operative recovery (time to liquid diet)

The mean post-operative recovery (time to liquid diet) in the intervention group was 0,87 days fewer (1,41 fewer to 0,33 fewer)

-

132
(2 observational studies)

⨁◯◯◯
VERY LOW ^b,h

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of intra-corporal anastomosis on the time to liquid diet compared to extra-corporal anastomosis.

Post-operative complications

333 per 1.000

270 per 1.000
(197 to 359)

OR 0.74
(0.49 to 1.12)

1658
(15 observational studies) ^a

⨁◯◯◯
VERY LOW ^b,f,i

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of intra-corporal anastomosis on the post-operative outcomes compared to extra-corporal anastomosis.

Hernia

86 per 1.000

41 per 1.000
(17 to 98)

OR 0.45
(0.18 to 1.16)

352
(6 observational studies) ^a

⨁◯◯◯
VERY LOW ^b,i

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of intra-corporal anastomosis on the odds of hernia compared to extra-corporal anastomosis.

Cosmetics - not reported

-

-

-

-

-

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; MD: Mean difference; OR: Odds ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Summary of findings:

Midline incision compared to pfannenstiel extraction for laparoscopic colorectal surgery (Lee 2017)

Patient or population: laparoscopic colorectal surgery

Setting:

Intervention: midline incision

Comparison: pfannenstiel extraction

Outcomes

Anticipated absolute effects^* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with pfannenstiel extraction

Risk with midline incision

Hernia (incisional hernia)

9 per 1.000

76 per 1.000
(28 to 189)

OR 8.63
(3.03 to 24.58)

2667
(7 observational studies)

⨁◯◯◯
VERY LOW ^a,b,c

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects of a midline incision on the odds of incicional hernia compared to extra-corporal anastomosis.

Post-operative recovery - not reported

-

-

-

-

-

Post-operative complications - not reported

-

-

-

-

-

Cosmetics - not reported

-

-

-

-

-

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; OR: Odds ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Summary of findings:

Pre-operative endoscopic tattooing compared to conventional localisation techniques for pre-operative localisation of the tumor (Acuna 2017)

Patient or population: pre-operative localisation of the tumor

Setting:

Intervention: pre-operative endoscopic tattooing

Comparison: conventional localisation techniques

Outcomes

Impact

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Localization error

Only 2 of the 32 studies directly compared the localization errors of colonoscopic tattooing with with conventional localization. One of these studies reported no significant associations (OR: 0.09, 95%CI: 0-1.75, n=47), while the other study reported a significant association (OR: 0.17, 95%CI: 0.04-0.72, n=310). Furthermore, lokalization errors from 18 studies were pooled describing conventional lokalization (error rate: 15.4%, 95%CI: 12-18.7, I2: 84.9%, n=2578) and 17 studies were pooled describing colonoscopic tattooing (error rate: 9.5%, 95%CI: 5.7-13.3, I2: 73.1%, n=643). Both pooled error rates were then compared and colonoscopic tattooing showed a significant lower error rate compared to conventional tattooing (mean difference: 5.9%, 95%CI: 0.65-11.14, p=0.03).

(32 observational studies)

⨁◯◯◯
VERY LOW ^a,b,c

Observational studies start out at a ‘Low’ grade.

We are unsure of the effects pre-operative endoscopic tattooing on the localization errors compared to conventional localization.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect