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

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

doi: 10.1097/SLA.0b013e3181ad6511
Original Articles

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.

We retrospectively compared 471 patients treated for rectal cancer by either laparoscopic or open surgery. We observed similar mortality, morbidity, R0 resection, local recurrence, and cancer-free survival at 5 years between the 2 groups, suggesting the efficacy of the laparoscopic procedure in a specialized team.

From the Department of Colorectal Surgery, Saint-Andre Hospital, University of Bordeaux, Bordeaux, France.

Presented at the third French Digestive and Hepatobiliary meeting, Paris, France, December 6–8, 2007; at the 10th World Congress on Gastrointestinal Cancer, Barcelona, Spain, June 25–28, 2008; and at the ESCP European Society of Coloproctology, Nantes, France, September 2008.

Reprints: Christophe Laurent, MD, PhD, Service de Chirurgie Digestive, Hôpital Saint-André, 33075 Bordeaux, France. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.