Comparison of laparoscopic vs. open access surgery in patients with rectal cancer: A prospective analysis

PURPOSE: Laparoscopic surgery of colon cancer has been accepted to be oncologically adequate compared with open resection. However, the situation in rectal cancer remains unclear, because anatomy and complex surgical procedures might specifically influence the long-term outcome. This study was designed to analyze perioperative and long-term outcome of patients with rectal cancer after laparoscopic vs. open access surgery. METHODS: A total of 389 patients (1998-2005) were prospectively analyzed; 114 patients had laparoscopic beginning, and 25 patients had conversion and were separately analyzed. Eighty-nine patients remained in the laparoscopic group and 275 had open access surgery. RESULTS: Both groups were comparable regarding age, gender, tumor localization, stage, and complications. Differences were found in harvested lymph nodes (laparoscopic 13.5/open access 16.9; P=0.001) and hospitalization (15.1/18.7 days; P=0.037). Local recurrence rate and metachronous metastasis were comparable. In patients with deep anterior resection with total mesenteric excision, favorable long-term survival in the laparoscopic group was found (P=0.035, log-rank). CONCLUSIONS: Minimally invasive surgery is equivalent in the treatment of rectal cancer and shows advantages of shorter hospitalization and faster recovery. Especially in patients with low rectal cancer, minimally invasive surgery with exact preparation of the total mesenteric excision seems to be favorable compared with open access surgery.