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Comment & Response
June 28, 2017

Pathologic Outcomes of Laparoscopic vs Open Mesorectal Excision For Rectal Cancer—Reply

Author Affiliations
  • 1Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Université Paris Est–Créteil, Créteil, France
  • 2Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
JAMA Surg. Published online June 28, 2017. doi:10.1001/jamasurg.2017.1725

In Reply We share a great enthusiasm toward laparoscopy and other minimally invasive techniques for rectal cancer surgery (eg, transanal and robotic resection).1 However, to our knowledge, a consensus on the gold-standard treatment has yet to be reached.

Two recent randomized clinical trials, the ALaCaRT2 and ACOSOG-Z60513 trials, raised the possibility of achieving a rate of adequate rectal resection by laparoscopy that is at least as good as by open surgery. Our meta-analysis4 further contributes to this debate, especially because the conclusions are in contrast with a previous meta-analysis published by Arezzo et al.5 It must be noted that Arezzo et al5 did not include data from the ALaCaRT2 and ACOSOG-Z60513 trials and used different within-study definitions for circumferential resection margin involvement or mesorectal fascial integrity. With very high degrees of heterogeneity, no comparison showed a statistically significant difference between laparoscopy and open surgery,5 but we must disagree with the interpretation of these results; finding no statistically significant difference between 2 treatments does not mean equivalence.

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