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Comment & Response
June 28, 2017

Pathologic Outcomes of Laparoscopic vs Open Mesorectal Excision for Rectal Cancer

Author Affiliations
  • 1Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 2Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  • 3Department of Surgery, St Michael’s Hospital, Toronto, Ontario, Canada
JAMA Surg. Published online June 28, 2017. doi:10.1001/jamasurg.2017.1724

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.

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