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

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-lip were standardized. Survival were analyzed by Kaplan Meier method and compared with the Log Rank test. Results: Some 47 1 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, anti 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.