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. 2024 Mar 15;103(11):e37474. doi: 10.1097/MD.0000000000037474

A systematic review and meta-analysis of minimally invasive versus conventional open proctectomy for locally advanced colon cancer

Zhang Peng a, Lu Ya b, Zhang Yichi a, Lin Dong c,*, Zhang Dechun a
PMCID: PMC10939686  PMID: 38489676

Abstract

Background:

Locally advanced colon cancer is considered a relative contraindication for minimally invasive proctectomy (MIP), and minimally invasive versus conventional open proctectomy (COP) for locally advanced colon cancer has not been studied.

Methods:

We have searched the Embase, Cochrane Library, PubMed, Medline, and Web of Science for articles on minimally invasive (robotic and laparoscopic) and COP. We calculated pooled standard mean difference (SMD), relative risk (RR), and 95% confidence intervals (CIs). The protocol for this review has been registered on PROSPERO (CRD42023407029).

Results:

There are 10132 participants including 21 articles. Compared with COP, patients who underwent MIP had less operation time (SMD 0.48; CI 0.32 to 0.65; I2 = 0%, P = .000), estimated blood loss (MD −1.23; CI −1.90 to −0.56; I2 = 95%, P < .0001), the median time to semi-liquid diet (SMD −0.43; CI −0.70 to −0.15; I2 = 0%, P = .002), time to the first flatus (SMD −0.97; CI −1.30 to −0.63; I2 = 7%, P < .0001), intraoperative blood transfusion (RR 0.33; CI 0.24 to 0.46; I2 = 0%, P < .0001) in perioperative outcomes. Compared with COP, patients who underwent MIP had fewer overall complications (RR 0.85; CI 0.73 to 0.98; I2 = 22.4%, P = .023), postoperative complications (RR 0.79; CI 0.69 to 0.90; I2 = 0%, P = .001), and urinary retention (RR 0.63; CI 0.44 to 0.90; I2 = 0%, P = .011) in perioperative outcomes.

Conclusion:

This study comprehensively and systematically evaluated the difference between the safety and effectiveness of minimally invasive and open treatment of locally advanced colon cancer through meta-analysis. Minimally invasive proctectomy is better than COP in postoperative and perioperative outcomes. However, there is no difference in oncological outcomes. This also provides an evidence-based reference for clinical practice. Of course, multi-center RCT research is also needed to draw more scientific and rigorous conclusions in the future.

Keywords: minimally invasive proctectomy, minimally invasive, conventional open proctectomy, locally advanced colon cancer, meta-analysis

1. Introduction

Minimally invasive proctectomy has been shown to provide important advantages in the short term when compared to open proctectomy for the treatment of several malignant diseases with at least the same long-term survival.[1,2] However, although minimally invasive proctectomy (MIP) has been accepted worldwide for early and middle rectal cancer, its application in advanced rectal cancer has not been widespread.[3,4] With the development of MIP, more and more patients choose minimally invasive.[5] Locally advanced rectal cancer, once considered a contraindication of MIP, is also feasible and has been proven to be effective and safe.[6–8]

Although many articles have been published on the comparison of early and middle rectal cancer.[9–11] There are few studies on locally advanced rectal cancer.[10] The treatment plan and results of the 2 stages of rectal cancer are significantly different.[12,13] Therefore, the results of minimally invasive early and middle rectal cancer proctectomy cannot be directly applied to locally advanced rectal cancer. Therefore, we think it is necessary to carry out in-depth research.

2. Methods

2.1. Protocol and guidance

The study was performed according to Preferred Reporting Items for Systematic Reviews and the meta-analysis[14] and the quality evaluation of this article was scored using the Newcastle-Ottawa Scale (NOS) score. The protocol for this review has been registered on PROSPERO (CRD42023407029).

2.2. Search strategy

This study involved literature published in the Embase, PubMed, Cochrane Library, Medline, and Web of Science up to August 03, 2023. We defined the eligibility criteria according to the population(P), intervention(I), comparator(C), outcome, and study design approach(O). P: the patients with locally advanced colon cancer. I: undergoing MIP. C: open was performed as a comparator. O: one or more of the following outcomes: perioperative period, postoperative indices, and oncologic outcomes. The search terms included (minimally invasive OR laparoscopic [Mesh] OR robot [Mesh]) AND (Open [Mesh]) AND (advanced colon cancer [Mesh]). The search strategy was not limited by language or year. It was not requested by the ethics or institutional review committee due to the study being designed as a systematic review and meta-analysis.

2.3. Inclusion and exclusion criteria

We have included the literature by the following criteria. Comparative data were available on the treatment of locally advanced colon cancer through minimally invasive and conventional open proctectomy (COP). Outcome indexes should include at least one of the following, perioperative period, postoperative, and oncologic outcomes. Any study which did not confirm the above inclusion criteria was excluded.

2.4. Data extraction and outcome measures

Two researchers (L.D. and Y.L.) independently reviewed the retrieved literature by the inclusion and exclusion criteria. The third researcher (Z.Y.C) was asked to participate in the discussion to decide whether to include when disagreements were encountered. The extracted data included the first author, publication, country, study type, group, age, follow-up, tumor height, and tumor size (if mentioned) (Table 1).

Table 1.

The main characteristics of included studies.

Author Publication Country Study period Study design Group Cases Age BMI(Body mass index) (kg/m2) ASA Follow-up (months) Confounders adjustment NOS score (max: 9)
Zhang et al (2017)[15] Surgical Laparoscopy, Endoscopy and Percutaneous Techniques China 2007–2013 Retrospective MIP (LPN) 47 71.9 ± 10.1 21.2 ± 2.2 97.9 47 (22–106) No 6
COP 65 69.4 ± 10.5 20.9 ± 2.1 93.8 59 (22–106)
Yang et al (2020)[16] Int J Colorectal Dis China 2010–2016 Retrospective MIP (LPN) 30 57.7 (12.6) 23.2 (2.5) 66.7 41.5 (3–98) No 7
COP 34 61.2 (13.3) 23.8 (2.7) 67.6 41.5 (3–98)
Yamaguchi et al (2018)[17] Surg Endosc Japan 2002–2014 Retrospective MIP (RPN) 78 63 (36–78) 22.7 (16.7–29.7) 94.9 54 (13.6–135) Yes (propensity score matching) 8
COP 78 61 (30–79) 22.7 (16.2–37.1) 93.5 54 (13.6–135)
Yamaguchi et al (2017)[18] Dis Colon Rectum Japan 2010–2011 Retrospective MIP (LPN) 118 59 (27–83) 90 (76.3) 98.3 43 Yes (propensity score matching) 8
COP 118 61 (40–84) 95 (80.5) 97.5 41.6
Yamaguchi et al (2016)[19] Surg Endosc Japan 2010–2014 Retrospective MIP (RPN) 85 63 (36–78) 22.8 (16.7–29.7) 92.9 No 8
COP 88 63 (26–84) 23.3 (16.2–30.2) 94.4
Watanabe et al (2021)[20] Surg Endosc Japan 2005–2016 Retrospective MIP (LPN) 93 64 (58.5–70.0) 23.0 (20.5–24.8) 55.6 (45.8–66) Yes (propensity score matching) 8
COP 93 64 (59.5–71.5) 23.0 (20.5–24.8) 55.6 (45.8–66)
Sujatha-Bhaskar et al (2017)[5] Ann Surg USA 2010–2014 Retrospective MIP (RPN) 2009 57 ± 12 No 9
COP 3399 58 ± 11
Seshadri et al (2012)[21] Surg Endosc India 2004–2010 Prospective MIP (LPN) 72 48 (22–73) 21 (15–33) 99 Yes (propensity score matching) 8
COP 72 48 (19–71) 22 (14–38) 96
Sasi et al (2021)[22] Colorectal Dis India 2014–2017 Retrospective MIP (LPN) 293 47.49 98.3 Yes (propensity score matching) 7
COP 293 47.04 98.3
Nonaka et al (2017)[23] Anticancer Res Japan 2008–2014 Retrospective MIP (LPN) 27 64.9 No 6
COP 17 62.4
Nishikawa et al (2019)[24] Dis Colon Rectum Japan 2007–2015 Retrospective MIP (LPN) 31 70.2 ± 10.8 2.8 Yes (propensity score matching) 7
COP 50 67.4 ± 13.0 2.8
Lim et al (2023)[10] Surg Today Japan 2005–2020 Prospective MIP (RPN) 64 63 (SD 10.4) 22.4 (SD 3.3) 60 (48–70) Yes (propensity score matching) 6
COP 65 61 (SD 9.3) 23.3 (SD 3.1) 116 (78–142)
Lee et al (2022)[7] J Laparoendosc Adv Surg Tech A Korea 2007–2017 Prospective MIP 30 56.83 23 No 7
COP 19 60.37 24
Law et al (2009)[25] Ann Surg Oncol China(Hong Kong) 2000–2006 Prospective MIP (LPN) 111 68.6 90.1 34 No 8
COP 310 67 85.8 34
Kim et al (2012)[26] Surg Endosc Korea 2001–2009 Retrospective MIP (LPN) 38 69.5 ± 8.8 23.3 ± 3.0 57.9 40 Yes (propensity score matching) 8
COP 16 68.1 ± 12.8 20.6 ± 2.4 62.5 35
Kusano et al (2014)[6] Jpn J Clin Oncol Japan 2002–2012 Retrospective MIP (LPN) 19 58 (32–82) 73.7%(<25) 35 No 6
COP 14 55 (39–73) 64.3%(<25) 40
Hida et al (2018)[27] Annals of surgery Japan 2010–2011 Retrospective MIP (LPN) 482 63.4 ± 13.1 22.5 3.6 95 39.6 Yes (propensity score matching) 9
COP 482 63.4 ± 10.9 22.4 3.4 94.4 39.6
Goto et al (2021)[28] Int J Colorectal Dis Japan 2008–2014 Retrospective MIP (LPN) 237 67 (60–73) 22.0 (20.2–24.0) 93.7 54 Yes (propensity score matching) 7
COP 237 67 (60–73) 22.5 (20.4–24.3) 94.1 54
Fleshman et al (2015)[29] Jama USA 2008–2013 Retrospective MIP (LPN) 242 57.7 (11.5) 26.4 (4.0) No 9
COP 239 57.2 (12.1) 26.8 (4.2)
de’Angelis et al (2017)[30] Surgical Endoscopy USA 2005–2015 Retrospective MIP (LPN) 62 70 (37–89) 26 (18.5–33) 56.5 34.37 (23.09) No 8
COP 75 68 (28–86) 25 (16–34) 62.7 43.81 (32.54)
Tang et al (2023)[31] Tech Coloproctol China 2012–2019 Retrospective MIP (LPN) 100 58 (30–85) 23.4 (17.5–33.0) 98 37 Yes (propensity score matching) 7
COP 100 57 (18–80) 23.8 (16.9–34.1) 100 46
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Matching: (1) age; (2) BMI; (3) follow-up.

COP = conventional open proctectomy, LPN = laparoscopic invasive proctectomy, MIP = minimally invasive proctectomy, NA = data not available, NOS score = Newcastle-Ottawa Scale score, RPN = robotic invasive proctectomy.

2.5. Statistical analysis

Statistical analysis was performed by Stata v.12.0 (Stata Corp LLC, College Station, TX). For this meta-analysis, if the heterogeneity test was I2 > 50%, P < .1, we used the random effect model; if the heterogeneity test was I2 < 50%, P > .1, we used the fixed utility model. The combined r values and 95% confidence intervals (CIs) of each study were calculated, and the forest map displayed the characteristics of each study result. The quality of the included literature was evaluated using the Newcastle–Ottawa scale (NOS). The Begg and Egger tests were used to test the publication bias. The P < .05 was indicated as statistically significant.

3. Results

3.1. Eligible studies and study characteristics

We initially searched 1402 records. 686 literature that was published repeatedly and cross-published were deleted. After reading the title and abstract, 584 articles were excluded. After the remaining 132 pieces of literature were searched for full text, reading, and quality assessment, 21 pieces of literature[5–7,10,15–31] (10,132 participants: MIP: 4268 vs COP: 5864) were eventually included (Fig. 1: Guidelines Flow Diagram). The detailed information on this literature is listed in Table 1.

Figure 1.

Figure 1.

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Flowchart for records selection process of the meta-analysis. (According to PRISMA template: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7): e1000097. doi:10.1371/journal. Pmed 1000097).

3.2. Perioperative outcomes

Data on operation time (OP) were reported in 4 studies.[16,23,26,29] Compared with COP, patients who underwent MIP had less OP (standard mean difference [SMD] 0.41; CI 0.25 to 0.57; I2 = 76.3%, P = .000). Owing to high heterogeneity (I2 = 76.3%), sensitivity analysis was carried out by Stata 12.0. After removing the studies by Nonaka et al[23] as the sample that was “left out,” the pooled results did not change substantially but the heterogeneity was significantly reduced (SMD 0.48; CI 0.32 to 0.65; I2 = 0%, P = .000) (Fig. 2A). We included 5 studies[16,21,23,26,29] about estimated blood loss (EBL). Compared with COP, patients who underwent MIP had less EBL (SMD −0.67; CI −0.80 to −0.55; I2 = 95%, P = .000). Owing to sensitivity analysis and subgroup analysis cannot reduce heterogeneity, we choose the random-effects model (MD −1.23; CI −1.90 to −0.56; I2 = 95%, P < .0001) (Fig. 2B). We included 3 studies[26,29,30] about length of stay. Compared with COP, patients who underwent MIP had no statistical difference (SMD 0.03; CI −0.13 to 0.19; I2 = 0%, P = .745) (Fig. 2C). We included 3 studies[16,26,30] about the median time to a semi-liquid diet. Compared with COP, patients who underwent MIP had a less median time to semi-liquid diet (SMD −0.43; CI −0.70 to -0.15; I2 = 0%, P = .002) (Fig. 2D). Data on time to the first flatus were reported in 3 studies.[15,26,30] Compared with COP, patients who underwent MIP had less time to the first flatus (SMD −0.76; CI −1.01 to −0.50; I2 = 57.6%, P < .0001). Owing to high heterogeneity (I2 = 57.6%), sensitivity analysis was carried out by Stata 12.0. After removing the studies by De’Angelis et al[30] as the sample that was “left out,” the pooled results did not change substantially but the heterogeneity was significantly reduced (SMD −0.97; CI −1.30 to −0.63; I2 = 7%, P < .0001) (Fig. 2E).

Figure 2.

Figure 2.

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Meta-analysis of minimally invasive proctectomy versus conventional open proctectomy for locally advanced colon cancer in perioperative outcomes: A: operation time, B: estimated blood loss C: length of stay, D: time to semi-liquid diet, E: time to the first flatus, F: intraoperative blood transfusion, G: retrieved lymph nodes, H: lymphatic invasion, I: venous invasion.

Data on intraoperative blood transfusion were reported in 7 studies.[6,18,20,26–28,31] Compared with COP, patients who underwent MIP had less intraoperative blood transfusion (relative risk [RR] 0.33; CI 0.24 to 0.46; I2 = 0%, P < .0001) (Fig. 2F). Data on the number of retrieved lymph nodes were reported in 4 studies.[10,16,22,24] Compared with COP, patients who underwent MIP had no statistical difference (SMD 0.06; CI −0.07 to 0.19; I2 = 68.1%, P = .386). Owing to high heterogeneity (I2 = 68.1%), sensitivity analysis was carried out by Stata 12.0. After removing the studies by Lim et al[10] as the sample that was “left out,” the pooled results did not change substantially but the heterogeneity was significantly reduced (SMD −0.01; CI −0.16 to 0.13; I2 = 29.9%, P = .240) (Fig. 2G).

We included 2 studies[6,10] about lymphatic invasion. Compared with COP, patients who underwent MIP had no statistical difference (SMD 0.84; CI 0.32 to 2.22; I2 = 0%, P = .724) (Fig. 2H). Data on venous invasion were reported in 2 studies.[10,24] Compared with COP, patients who underwent MIP had no statistical difference (RR 0.81; CI 0.60 to 1.09; I2 = 73.3%, P = .170). Owing to sensitivity analysis and subgroup analysis cannot reduce heterogeneity, we choose the random-effects model (RR 0.81; CI 0.60 to 1.09; I2 = 73.3%, P = .170) (Fig. 2I).

3.3. Postoperative outcomes

Data on overall complications were reported in 4 studies.[10,22,25,29] Compared with COP, patients who underwent MIP had lower overall complications (RR 0.85; CI 0.73 to 0.98; I2 = 22.4%, P = .023) (Fig. 3A). We included 7 studies[13,15,20,23,26,27,30] about postoperative complications. Compared with COP, patients who underwent MIP had lower postoperative complications (RR 0.79; CI 0.69 to 0.90; I2 = 0%, P = .001) (Fig. 3B).

Figure 3.

Figure 3.

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Meta-analysis of minimally invasive proctectomy versus conventional open proctectomy for locally advanced colon cancer in postoperative outcomes: A: overall complications, B: postoperative complications, C: abdominal abscess, D: anastomotic leakage, E: intestinal obstruction, F: pulmonary infection, G: surgical site infection, H: urinary retention, I: wound infection, J: reoperation within 30 days after surgery.

We included 3 studies[6,13,31] about abdominal abscesses. Compared with COP, patients who underwent MIP had no statistical difference (RR 0.80; CI 0.35 to 1.81; I2 = 0%, P = .591) (Fig. 3C). Data on anastomotic leakage were reported in 10 studies.[10,15,16,18,20,22,23,27,29,31] Compared with COP, patients who underwent MIP had no statistical difference (RR 0.83; CI 0.64 to 1.08; I2 = 0%, P = .174) (Fig. 3D). We included 12 studies[6,10,15,16,18–20,26,27,29–31] about intestinal obstruction. Compared with COP, patients who underwent MIP had no statistical difference (RR 0.78; CI 0.58 to 1.03; I2 = 18.7%, P = .084) (Fig. 3E). We conducted subgroup analysis, compared with COP, patients who underwent laparoscopic or robot invasive proctectomy had no statistical difference (RR 0.84; CI 0.62 to 1.14; I2 = 2.7%, P = .254, RR 0.48; CI 0.21 to 1.11; I2 = 71.6%, P = .0.086) (Fig. S3E, Supplemental Digital Content, http://links.lww.com/MD/L945). Data on pulmonary infection were reported in 3 studies.[15,30,31] Compared with COP, patients who underwent MIP had no statistical difference (RR 0.47; CI 0.18 to 1.20; I2 = 0%, P = .113) (Fig. 3F). We included 2 studies[10,23] about surgical site infection. Compared with COP, patients who underwent MIP had no statistical difference (RR 0.68; CI 0.22 to 2.12; I2 = 0%, P = .501) (Fig. 3G). Data on urinary retention were reported in 4 studies.[18–20,31] Compared with COP, patients who underwent MIP had less urinary retention (RR 0.63; CI 0.44 to 0.90; I2 = 0%, P = .011) (Fig. 3H). We included 6 studies[15,16,18,20,26,27] about wound infection. Compared with COP, patients who underwent MIP had no statistical difference (RR 0.69; CI 0.48 to 1.01; I2 = 0%, P = .057) (Fig. 3I).

Data on reoperation within 30 days after surgery were reported in 3 studies.[18,20,25] Compared with COP, patients who underwent MIP had no statistical difference (RR 1.06; CI 0.57 to 1.98; I2 = 14.6%, P = .860) (Fig. 3J).

3.4. Oncological outcomes

Two studies[5,30] recorded 90-d mortality, and 3 studies[10,15,26] recorded local recurrence. There are similarities between minimally invasive and COP for 90-d mortality (RR 1.10; CI 0.51 to 2.39; I2 = 47.7%, P = .809) (Fig. 4A) and local recurrence (RR 0.66; CI 0.37 to 1.18; I2 = 0%, P = .158) (Fig. 4B).

Figure 4.

Figure 4.

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Meta-analysis of minimally invasive proctectomy versus conventional open proctectomy for locally advanced colon cancer in oncological outcomes: A: 90-d mortality, B: local recurrence.

4. Publication bias

We conducted publication bias on more than 10 included studies using Begg test. For anastomotic leakage, Begg test results revealed that t = −1.07, P = .318 in Figure S1A, Supplemental Digital Content, http://links.lww.com/MD/L943. For intestinal obstruction. Begg test results revealed that t = −2.62, P = .056 in Figure S1B, Supplemental Digital Content, http://links.lww.com/MD/L944. There is no publication bias except circumferential proctectomy margin in the above.

5. Discussion

In recent decades, laparoscopic surgery has made great progress in the treatment of rectal cancer, and it has entered a new world. However, there are still shortcomings in laparoscopic surgery in the radical proctectomy of middle and lower rectal cancer. First of all, the laparoscopy needs to be completed by the operator, the hander, and the assistant. If the adjustment is not good, the operation is difficult to complete. Because the hander receives and grasps the lens, the picture is unstable, the exposure of the surgical field of vision is limited, and the two-dimensional display also lacks three-dimensional sense.[32,33] Secondly, the middle and lower rectum are located in the small pelvis, and the position is deep. There is no movable joint at the head of the surgical instrument under the endoscope, which is limited due to its limitations. Thirdly, it is not easy to accurately operate the dissection of lymph nodes at the root of mesenteric blood vessels and the disconnection of blood vessels, and the physical tremor of human hands increases the risk of surgery. Robot surgery system is a revolutionary technology, which has been successfully introduced into clinical practice.[34,35] The requirements for minimally invasive surgery for locally metastatic rectal cancer are higher, which also puts forward higher requirements for minimally invasive equipment and personnel.[3,36]

The choice of minimally invasive surgery depends on the experience and skills of surgeons, and the most important thing is to comprehensively consider tumor factors (such as tumor location and severity) and patient factors (such as obesity and previous abdominal surgery history).[37] Whether it is open surgery or minimally invasive surgery, the lymphatic drainage area of rectal cancer varies with the tumor location. The lymphatic drainage direction of lower rectal cancer is more upward and lateral, while upper rectal cancer is more upward and along the mesenteric vessels.[38,39]

A thorough dissection of lymph nodes is an important factor in the staging of rectal cancer. The American Cancer Federation and the American Pathological Society recommend that 12 lymph nodes be evaluated to accurately identify early rectal cancer. The number of lymph nodes available varies with the patient’s age, sex, tumor stage, and tumor location. The number of lymph node dissections is positively correlated with survival prognosis. It has been proved that the more lymph node dissection, the better the survival prognosis.[40]

For COP, MIP is characterized by less OP, EBL, length of stay, the median time to semi-liquid diet, time to the first flatus, and complications due to its small wound and small trauma. There was no significant difference in long-term oncology. In terms of long-term effects after surgery, this study analyzed that there was no statistical difference between the 2 groups in 90-d mortality and local recurrence.

Of course, our research also has some limitations: 1. The included studies are retrospective studies or prospective cohort studies, which will inevitably be affected by selection bias. 2. In terms of the baseline report of the cases included in the literature, only some of them were provided. Of course, we analyzed the baseline data that can be extracted from the included literature, but we still lacked the comprehensiveness of the data, and could not conduct subgroup analysis according to general characteristics, such as male-female ratio, BMI value, etc. 3. In the data analysis, although we conducted a sensitivity analysis on highly heterogeneous outcome indicators, some results did not identify the source of their heterogeneity. 4. In terms of analysis indicators, the long-term efficacy, such as local tumor recurrence rate, was not analyzed by subgroup according to the follow-up time, while only 2 to 3 articles were included in 90-d mortality and local recurrence, and the number of articles included in the analysis was insufficient. 5. At present, the follow-up time of various studies is limited, and not enough long-term efficacy data is provided for analysis. In terms of functional outcome data, only kinds of literature mention it and it is not uniformly quantified, which causes certain difficulties in analysis.

6. Conclusion

This study comprehensively and systematically evaluated the difference between the safety and effectiveness of minimally invasive and open treatment of locally advanced colon cancer through meta-analysis. Minimally invasive proctectomy is better than COP in postoperative and perioperative outcomes. However, there is no difference in oncological outcomes. This also provides an evidence-based reference for clinical practice. Of course, multi-center RCT research is also needed to draw more scientific and rigorous conclusions in the future.

Acknowledgments

This work was supported by the Project of Chengdu Municipal Health Commission (2022124, 2023611) and Scientific Research Foundation of Health and Family Planning Commission of Sichuan Province (20PJ236).

Author contributions

Conceptualization: Zhang Peng.

Data curation: Zhang Yichi.

Formal analysis: Zhang Peng.

Funding acquisition: Zhang Yichi.

Investigation: Zhang Peng.

Methodology: Zhang Yichi.

Project administration: Zhang Peng.

Resources: Lu Ya, Zhang Yi Chi, Lin Dong.

Software: Zhang Peng, Lu Ya, Lin Dong.

Supervision: Lin Dong.

Validation: Lu Ya, Lin Dong.

Visualization: Zhang Dechun.

Writing – original draft: Zhang Dechun.

Writing – review & editing: Zhang Dechun.

Supplementary Material

medi-103-e37474-s003.docx (14.1KB, docx)

Abbreviations:

CIs
confidence intervals
COP
conventional open proctectomy
EBL
estimated blood loss
MIP
minimally invasive proctectomy
OP
operation time
RR
relative risk
SMD
standard mean difference

The authors have no conflicts of interest to disclose.

There is not involve ethics because it is the system review and meta-analysis.

Supplemental Digital Content is available for this article.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Peng Z, Ya L, Yichi Z, Dong L, Dechun Z. A systematic review and meta-analysis of minimally invasive versus conventional open proctectomy for locally advanced colon cancer. Medicine 2024;103:11(e37474).

Contributor Information

Zhang Peng, Email: 9104575@qq.com.

Lu Ya, Email: 1406865932@qq.com.

Zhang Yichi, Email: 9104575@qq.com.

Zhang Dechun, Email: 9104575@qq.com.

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