Impact of previous abdominal surgery on minimally invasive radical resection of colorectal cancer: A meta-analysis.

The suitability of minimally invasive surgery (MIS) for colorectal cancer (CRC) in patients who have undergone previous abdominal surgery (PAS) is controversial. This study aimed to analyse the effect of PAS on MIS in patients with CRC. We performed a meta-analysis by searching the Web of Science, MEDLINE, Embase, and Cochrane Library databases from their inception until March 2024. All published studies exploring the effects of PAS on laparoscopic or robot-assisted radical resection for CRC were included. In total, 1271 studies were retrieved, of which 12 were included in the meta-analysis, including 11,528 patients with CRC. The results showed that the conversion of minimally invasive procedures to open surgery was more common in patients with PAS (odds ratio [OR] = 1.57, p < 0.0001), and most of them were due to abdominal adhesions (OR = 5.01, p < 0.0001). The time to the first flatus was prolonged (weighted mean difference = 0.24, p = 0.008), and patients with PAS were more likely to develop ileus (OR = 1.40, p = 0.03) after surgery. The operative time, intraoperative blood loss, lymph node harvest, overall and major postoperative complications, reoperation, and mortality did not increase significantly. In addition, subgroup analysis revealed that major PAS increased the incidence of overall postoperative complications in patients with CRC (OR = 2.61, p = 0.003), whereas minor PAS was comparable to the postoperative clinical outcomes in patients without PAS. Generally, MIS is safe and effective for patients with CRC and PAS. Surgeons should not discourage patients with PAS from undergoing MIS while improving their experience with laparoscopic or robotic surgery.