Keyhole surgery versus open surgery in rectal cancer: Which is really better?

This paper examined the short- and long-term benefits of keyhole surgery compared to open surgery.

Laparoscopic surgery (also known as keyhole surgery) is surgery where one or more small cuts are made in the skin. This type of surgery leads to faster recovery times, better cosmetic results and fewer complications. However, the long-term results of keyhole surgery have not been well studied. Therefore, open surgery (when one large incision is made) is generally recommended in rectal cancer patients.

The current study explored the short- and long-term benefits of keyhole surgery compared to open surgery. The authors analyzed 13 studies including 2,973 patients. Almost half of this group had open surgery and the other had keyhole surgery.

Keyhole surgery took less time and patients had less blood loss than during open surgery. During keyhole surgery, 70% fewer patients needed a transfer of blood (transfusion).

Patients who underwent keyhole surgery resumed eating a regular diet significantly faster than those who had open surgery. There was no major difference between keyhole and open surgery in the number of  cancer cells found in the outer edges of the removed tissue (the margins).

There was a 28% reduction in complications for patients receiving keyhole surgery. Wound infection rates were 81% lower following keyhole surgery than open surgery.

There were no long-term differences in the outcomes of keyhole surgery compared to open surgery. There were no significant differences in local recurrence (return of cancer at the same site) or distant recurrence (cancer return at a distant site) rates. Disease-free survival (time from treatment until disease return) and overall survival (time from treatment until death from any cause) rates were also similar.

The authors concluded that keyhole surgery was associated with better short-term outcomes and similar long-term outcomes compared to open surgery.

More studies are necessary to analyze quality of life and sexual/urinary function following either keyhole or open surgery.

Discuss this article with your doctor to determine which option is best for you.