To the Editor The systematic review by Martínez-Pérez et al1 highlights the debate regarding the oncologic safety of the laparoscopic approach for rectal cancer, reignited by the 2 most recent randomized clinical trials.2,3 These trialists selected a noninferiority design, in which a prespecified small loss in treatment effect, known as the noninferiority margin (ΔNI), is acceptable, given other advantages of the new treatment (ie, short-term benefits of laparoscopy). Martínez-Pérez et al1 conducted an extensive literature search and used adequate pooling methods in their review, yet clinical interpretation of their findings, which do not take the ΔNI into consideration, can result in misleading conclusions.
Acuna SA, Chesney TR, Baxter NN. Pathologic Outcomes of Laparoscopic vs Open Mesorectal Excision for Rectal Cancer. JAMA Surg. Published online June 28, 2017. doi:10.1001/jamasurg.2017.1724