Abstract
BACKGROUND: Laparoscopic segmental resection (LSR) is a common treatment modality for endoscopically unresectable colorectal polyps. Laparoscopic endoscopic cooperative surgery (LECS) has emerged as a promising alternative, yet current evidence of its efficacy remains limited. OBJECTIVES: This meta-analysis aims to compare the therapeutic outcomes of LECS versus LSR for endoscopically unresectable colorectal polyps and to provide robust evidence for clinical practice. METHODS: This meta-analysis was prospectively registered on the PROSPERO website. We systematically searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM for randomized controlled trials (RCTs) and observational studies from database inception to May 16, 2025. Data analysis was conducted using Review Manager 5.4 and Stata 18 software. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: A total of 13 studies involving 715 patients were included in this study. Meta-analysis results showed that the LECS group had a significantly shorter length of hospital stay (MD: -2.89 days, 95% CI: -3.43 to -2.34, 13 studies, 715 patients), shorter operation time (MD: -41.62 min, 95% CI: -56.96 to -26.28, 12 studies, 593 patients), fewer postoperative overall complications (OR: 0.29, 95% CI: 0.17 to 0.49, 9 studies, 513 patients), and lower estimated blood loss (MD: - 26.12 mL, 95% CI: -37.07 to -15.17, 8 studies, 435 patients) when compared to the LSR group. CONCLUSIONS: LECS demonstrates superior short-term outcomes compared to LSR and should be considered a preeminent alternative for endoscopically unresectable colorectal polyps. However, long-term efficacy remains to be confirmed by well-designed, high-quality trials.