This study compared patient outcomes after laparoscopic surgery (a modern, minimally-invasive technique involving very small incisions) and minilaparotomy (a larger incision is made which allows direct visualization of the surgery).

Surgery is the main treatment for rectal cancer. Open surgery is the original surgical technique and involves making a large incision to remove the tumor. Laparoscopic surgery is a newer technique which reduces blood loss, pain and the length of hospital stay compared to open surgery. Despite these benefits it is a difficult operation, has a long operation time, and is very costly.

A third surgical technique has received less attention: minilaparotomy. This technique eliminates the need for expensive equipment and decreases the training needed for surgeons. However, it is not known if the outcome for patients is as good as with laparoscopic surgery.

122 patients were included in this study. They were separated into two groups: 65 patients in the minilaparotomy group and 57 in the laparoscopic surgery group. The authors compared the short-term and long-term outcomes for both surgical techniques.

There was no difference in the number of complications after surgery between the two groups. The average minilaparotomy surgery time (145 min) was significantly shorter than laparoscopic surgery (167 min). The average cost of minilaparotomy ($3913) was also significantly lower than laparoscopic surgery ($5533). However, the average hospital stay was longer for minilaparotomy (8 days) than for laparoscopic surgery (7 days). The average time it took to return to having a normal diet was also longer for minilaparotomy (5 days) than for laparoscopic surgery (4 days).

The long-term outcomes of both techniques were similar. There was no difference in 5 year survival rates: 82.5% for minilaparotomy and 87.1% for laparoscopic surgery. 71.4% of the minilaparotomy group and 74.2% of the laparoscopic surgery group remained disease free over the 5 year follow-up. 

The authors concluded that the cost effective minilaparotomy is as safe as laparoscopic surgery. However, despite shorter operation time patients have a slightly longer recovery time after minilaparotomy.