Four RCT were included in the review (331 patients). One study was excluded because it was from the same center as another and had a lower quality score. Different outcomes of one of the trials were published in two articles, but they were analysed as one. Three studies had a Jadad score of 5 or more; one had the lowest possible score of 2. Mean follow-up ranged from six to 44 months.
Statistically significant heterogeneity was noted for overall postoperative complications, blood loss and operation time.
Primary outcomes: Recurrence, overall survival and disease-free survival were reported by three studies and no significant difference was shown in any of them. Three studies reported intraoperative complications, for which LAS was associated with fewer intraoperative complications than open surgery (OR 0.33 95% CI 0.13 to 0.84).
Postoperative complications: All studies reported this outcome. Overall postoperative complications were lower in the LAS group (OR 0.34, 95% CI 0.13 to 0.89). The sole individual postoperative complication that showed a significant difference was a lower incidence of transfusion in the LAS group (OR 0.14, 95% CI 0.05 to 0.39). There were no statistically significant differences in incidence of urinary tract infection, haematoma, fever above 38ºC, ileus or wound infection.
Operative parameters: Three studies reported these outcomes. There was no significant difference in hemoglobin drop; however, blood loss was significantly lower in the LAS group (WMD -263.58 mL, 95% CI -467.71 to -59.45). Operation time was shorter in the open surgery group (WMD 37.78 minutes, 95% CI 10.5 to 65.68, p<0.05), with statistically significant heterogeneity (p=0.02). Neither harvested para-aortic or pelvic lymph nodes showed statistically significant differences. Hospital stay was significantly shorter in the LAS group (WMD -3.35 days, 95% CI -3.84 to -2.86).
Funnel plot analysis was performed only for urinary tract infection.