Laparoscopic vs. Open Surgery for Low Rectal Cancer

Laparoscopic surgery has been increasingly performed in recent decades across the spectrum of gastrointestinal malignancies, including rectal cancer. Is this approach as safe and effective as open surgery for patients with low rectal cancers?

To find out, investigators in China conducted a multicenter, noninferiority, randomized trial involving 1039 patients (median age, 57; 60% male) with locally advanced low-lying rectal cancers (63% clinical stage II/III; median distance from dentate line, 3 cm). Patients were assigned 2:1 to laparoscopic surgery (by surgeons who had performed >100 laparoscopic total mesorectal excision procedures) or open surgery.

Initial results, at 30 days postsurgery, were as follows:

• Operative time was longer with laparoscopic versus open surgery (195 vs. 180 min; P<0.001).
• Rates of intraoperative complications were similar between laparoscopic and open surgery (1.8% and 2.0%, respectively), as were rates of postoperative complications (13.0% and 17.2%).
• Durations of postsurgical analgesic use were shorter with laparoscopic versus open surgery (45.0 vs. 48.0 hours; P=0.001), as were hospital stays (8.0 vs. 9.0 days; P=0.008), and time to first defecation (61.2 vs. 66.3 hours; P=0.03).
• The rate of sphincter preservation was higher with laparoscopic versus open surgery (71.7% vs. 65.0%; P=0.03).
• The rate of anastomotic leak was lower with laparoscopic versus open surgery (2.5% vs. 5.1%).
• Rates of negative margins were similar between laparoscopic and open surgery (98.2% and 99.7%), as were rates of complete total mesorectal excision (85.3% and 85.8%) and the median number of lymph nodes retrieved (12.0 and 13.0).