COMMENTARY

Laparoscopic vs Open Surgery for Rectal Cancer

Albert B. Lowenfels, MD

Disclosures

April 12, 2017

courtesy of National Institutes of Health.

Is laparoscopic surgery superior, inferior, or equal to open surgery for management of patients with rectal cancer? To help resolve this issue, the authors of a study published in JAMA Surgery performed a meta-analysis of 14 randomized trials comparing the two different surgical approaches in trials involving 2989 patients with excision of the rectum.[1] The main outcome measurement was noncomplete mesorectal excision, which was present in 13.2% of patients undergoing laparoscopic resection compared with 10.4% of patients treated by open surgery (P=.02). Other potentially important measures, such as the number of lymph nodes resected or the distance to the distal margin, were not significantly different.

Viewpoint

There is considerable controversy about the best surgical operative method for management of lower bowel cancer. It seems reasonable that in this anatomic region with limited visibility, a laparoscopic approach would allow for more complete tumor removal.

However, in the summary results from combining available published reports of randomized trials, the current overall results suggest that noncomplete tissue excision is increased by about 30% in patients undergoing laparoscopic surgery.

Is this the final word on the topic? Not at all. Surgeons need to wait until comparative randomized trials with long-term survival data are available.

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