Comparison between laparoscopic and open surgery of rectal cancer in terms of pathological findings and early outcome: a randomized controlled trial

Background
Laparoscopic surgery has progressively replaced open colonic surgery in recent decades owing to favorable short-term outcomes, such as less pain, reduced blood loss, and improved recovery time. The current study was designed to compare laparoscopic surgery with open surgery in patients with rectal cancer by incorporating clinical endpoints and detailed pathological analysis of all resected samples.
Methods
A prospective randomized controlled trial was conducted to compare laparoscopic surgery with open surgery for rectal cancer patients. The primary endpoint was postoperative clinical outcome in terms of morbidity and mortality. Secondary endpoints were adequacy of surgical margins and number of lymph nodes harvested for rectal cancer cases.
Results
Sixty patients underwent 40 laparoscopic and 20 open rectal resections between January 2014 and January 2016. There was no mortality, and there were significantly improved short-term surgical outcomes (less blood loss, less use of epidural analgesia, earlier restoration of bowel function, and reduction of the hospital stay) in the laparoscopic group. There were similar rates of intraoperative complications as open surgery, and the incidence of anastomotic leakage was similar between the two techniques. The conversion rate in the laparoscopic group was 12.5%. The short-term outcomes of the current study showed that the radicality of laparoscopic resection (as assessed by pathology report) in patients with rectal cancer is no different from that of open surgery; the median number of lymph nodes harvested for malignancies was 14 in the laparoscopic group and 13 in the open surgery group.
Conclusion
Laparoscopic surgery in patients with rectal cancer may confer clinical benefits in terms of faster recovery, smaller incisions, and a shorter hospital stay. The procedure can be technically difficult and time consuming. Laparoscopic resection of rectal cancer provided oncological radicality, using the pathology report as a proxy, similar to open surgery. Long-term follow-up to assess local recurrence and survival is necessary to ascertain oncological safety of laparoscopic resection in patients with rectal cancer.