Comparing the safety and efficacy of laparoscopic versus open surgery for patients with rectal cancer

The present study compared the safety and efficacy of laparoscopic surgery (LS) and open surgery (OS) in patients with rectal cancer. The study found that LS was as safe and effective as OS in selected patients with rectal cancer.

Rectal cancer is cancer in the lower part of the large intestine (rectum). Most patients with rectal cancer are candidates for surgery called a total mesorectal excision (complete removal of the rectum along with the fatty tissue, blood vessels and lymph nodes surrounding it). This procedure can be performed by one of two main techniques: OS (traditional) or LS (minimally invasive surgery done with a video camera through small cuts). Each surgery must be evaluated to make sure that results from LS are as good, or better than OS. 

This phase 3 clinical trial included 1044 patients with rectal cancer who underwent either LS (699 patients) or OS (345 patients). Patients in the LS group lost less blood during surgery (200ml versus 400ml), had shorter hospital stay (8 versus 9 days) and regained their bowel function sooner (2 versus 3 days) compared to patients in the OS group. However, LS took longer than OS (240 versus 188 minutes). The pathology results and surgery complication rates were similar between the two groups.

In conclusion, in selected patients with rectal cancer LS had similar efficacy, safety and complication rates to those of OS. In addition, patients who received LS had improved recovery compared to those in the OS group.

This study presents only partial results of this trial. Long-term results and local recurrence rates of the trial are expected by the end of the year 2013. This study is limited by the fact that patients received different treatments before surgery (chemotherapy, radiotherapy or none) which could influence their outcomes.