Systematic review of quality of life following laparoscopic and open colorectal surgery
To compare the health-related quality of life (HRQoL) of patients following laparoscopic and open colorectal surgery. Method
A systematic review was performed according to Quorum guidelines. Prospective studies comparing the HRQoL of patients after laparoscopic and open colorectal surgery were identified. The primary outcome measure was postoperative quality of life; performance status and cosmesis were secondary outcome measures. Results
Twenty-three studies were identified that satisfied the inclusion criteria; 18 assessed HRQoL, four performance status, and three cosmesis. It was not possible to perform a meta-analysis due to study heterogeneity. The studies reported outcomes for 2946 patients. The most frequent HRQoL instruments employed were Short Form 36, European Organization for Research and Treatment of Cancer, and gastrointestinal quality of life index. Six studies, using a total of 12 separate measures, evaluated QoL during the first three postoperative months: 10 of these measures showed no significant difference, and two showed an improved HRQoL with laparoscopy. Twelve further studies evaluated HRQoL up to 5 years postoperatively: nine showed no difference between the two groups, and three demonstrated a benefit for laparoscopy. Three of four studies assessing performance status on discharge, and all three studies assessing cosmesis, reported benefits with the laparoscopic approach. Conclusions
The current evidence suggests there is no significant difference in HRQoL following laparoscopic and open colorectal surgery, although there is a lack of good quality data. There is a trend towards improved quality of life outcomes and performance status with laparoscopy in the early postoperative period. There is a need for further research, particularly assessing quality of life in the early postoperative period.
Document Type: Review Article
Affiliations: 1: Minimal Access Therapy Training Unit, Postgraduate Medical School, Manor Park, Guildford, Surrey, UK 2: Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, UK 3: Departments of Social Sciences 4: Health Economics, University of Surrey, Guildford, Surrey, UK
Publication date: 01 October 2008