Laproscopic surgery leads to better postoperative outcomes than open surgery in rectal cancer

This study explored whether laproscopic surgery following neoadjuvant chemoradiotherapy is superior to open surgery in rectal cancer patients.

Two types of surgery are commonly used in the treatment of colorectal cancer. In open surgery, one large incision is made, while in laproscopic surgery several small incisions are made. Laproscopic surgery can lead to better short- and long-term outcomes in colon cancer, however, it is not clear whether the same is true in rectal cancer. Previous research has found that laproscopic surgery is equal to open surgery in terms of recurrence and survival rates, but these studies did not take into account chemoradiotherapy delivered prior to surgery. 

Neoadjuvant chemotherapy and radiation therapy (chemotherapy and radiation therapy that are given before surgery) have been shown to lead to fewer postoperative toxicities, as well as other benefits, but when combined with open surgery can increase blood loss and postoperative complications. The current analysis explored whether laproscopic surgery is superior to open surgery following neoadjuvant chemoradiotherapy in rectal cancer patients.

This analysis included 8 studies and 953 patients, the majority of whom had stage 2 or stage 3 rectal cancer, and all of whom underwent neoadjuvant chemoradiotherapy. 451 patients underwent open surgery and 502 underwent laproscopic surgery.

Postoperative complication rates were not significantly different in laproscopic surgery compared to open surgery (22.7% and 25.7%, respectively), and there were similar rates of positive margins (cancer cells found on the edges of the removed tissue, indicating some cancer cells may have been left behind): 2.5% of patients had positive margins following laproscopic surgery compared to 5.9% following open surgery.

Blood loss was 77.1 ml less following laproscopic surgery, and open surgery patients were 75% more likely to need a blood transfusion during surgery.

Following laproscopic surgery, the first defecation was 1.3 days sooner, a normal diet was resumed 0.7 days sooner, and patients spent 1 less day in the hospital than open surgery patients.

This study concluded that in rectal cancer patients who underwent neoadjuvant chemoradiotherapy, laproscopic surgery leads to similar postoperative complications, but significantly better short-term outcomes than open surgery.

Long-term outcomes, however, were not compared in this study. To fully understand whether laproscopic surgery is superior to open surgery in rectal cancer treatment, long-term outcomes and survival must be determined.