To the Editor In their recent article in JAMA Surgery, Martínez-Pérez et al1 question the oncological safety of laparoscopic surgery in patients with rectal cancer. Their conclusion differs from the findings of a systematic review by Arezzo et al,2 who concluded that laparoscopic resection of rectal cancer was oncologically safe. Inclusion of the early results of the ACOSOG and ALaCaRT trials in the meta-analysis by Martínez-Pérez et al1 led to their recommendation to await long-term outcome studies before determining the definitive role of laparoscopic surgery in patients with rectal cancer. Although more than 400 patients were accrued in both trials, the 95% CIs of the ACOSOG and ALaCaRT trials ranged from −11.0 and −12.4, respectively, to infinity, qualifying these trials as level 2b according to the Oxford Levels of Evidence.3
Koedam TWA, Bonjer HJ, Lacy AM. Pathologic Outcomes of Laparoscopic vs Open Mesorectal Excision for Rectal Cancer. JAMA Surg. 2017;152(10):986. doi:10.1001/jamasurg.2017.1723
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