Laparoscopic Versus Open Surgery for Rectal Cancer: Long-Term Oncologic Results

Long-Term Oncologic Results

Laurent, Christophe MD, PhD; Leblanc, Fabien MD; Wütrich, Philippe MD; Scheffler, Mathieu MD; Rullier, Eric MD


Annals of Surgery. 2009;250(1):54-61. 

In This Article

Abstract and Introduction


Objective: The goal was to assess long-term oncologic outcome after laparoscopic versus open surgery for rectal cancer and to evaluate the impact of conversion.
Summary Background Data: Laparoscopic resection of rectal cancer is technically feasible, but there are no data to evaluate the long-term outcome between laparoscopic and open approach. Moreover, the long-term impact of conversion is not known.
Methods: Between 1994 and 2006, patients treated by open (1994-1999) and laparoscopic (2000-2006) curative resection for rectal cancer were included in a retrospective comparative study. Patients with fixed tumors or metastatic disease were excluded. Those with T3-T4 or N+ disease received long course preoperative radiotherapy. Surgical technique and follow-up were standardized. Survival were analyzed by Kaplan Meier method and compared with the Log Rank test.
Results: Some 471 patients had rectal excision for invasive rectal carcinoma: 238 were treated by laparoscopy and 233 by open procedure. Postoperative mortality (0.8% vs. 2.6%; P = 0.17), morbidity (22.7% vs. 20.2%; P = 0.51), and quality of surgery (92.0% vs. 94.8% R0 resection; P = 0.22) were similar in the 2 groups. At 5 years, there was no difference of local recurrence (3.9% vs. 5.5%; P = 0.371) and cancer-free survival (82% vs. 79%; P = 0.52) between laparoscopic and open surgery. Multivariate analysis confirmed that type of surgery did not influence cancer outcome. Conversion (36/238, 15%) had no negative impact on postoperative mortality, local recurrence, and survival.
Conclusions: The efficacy of laparoscopic surgery in a team specialized in rectal excision for cancer (open and laparoscopic surgery) is suggested with similar long-term local control and cancer-free survival than open surgery. Moreover, conversion had no negative impact on survival.


The advent of minimally invasive surgical techniques has given surgeons the option of a laparoscopic approach in the treatment of colorectal cancer. The safety and oncologic efficacy of laparoscopy has been demonstrated for colonic cancer[1,2,3,4,5] with recently confirmation of similar long-term results at 5-year from the COST study group trial.[6] However, regarding rectal cancer surgery laparoscopic resection remains controversial mainly because of a steep learning curve and technical challenges, including difficulties for pelvic exposure, rectal dissection, and sphincter preservation[7,8,9,10,11] and more importantly a lack of long-term data from large scale series.

A recent meta-analysis including 3 randomized studies has compared laparoscopic versus open surgery specifically for rectal cancer;[12] however, only short- and mid-term outcomes are available. Clearly, laparoscopic rectal resection is feasible with similar complication rates, less pain, an earlier return of bowel function, a shorter hospital stay and facilities to resume social activities compared with open surgery. Nevertheless, technical difficulties induce a high rate of conversion that may increase morbidity, especially in converted patients.[13] Although the oncologic safety seems to be identical between laparoscopic and open rectal excision with similar rates of safe margins,[12] there is no comparative data evaluating the 5-year survival. In addition, the long-term outcome of converted patients has never been investigated.

Because definitive long-term results are not yet available, oncologic adequacy of laparoscopic total mesorectal excision (TME) for treatment of rectal cancer remains unproven. The aim of our comparative retrospective study was to assess long-term outcome after laparoscopic versus open surgery for rectal cancer, and to evaluate the long-term impact of conversion.


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