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.
de’Angelis N, Martínez-Pérez A, Brunetti F. Pathologic Outcomes of Laparoscopic vs Open Mesorectal Excision For Rectal Cancer—Reply. JAMA Surg. Published online June 28, 2017. doi:10.1001/jamasurg.2017.1725