Introduction Laparoscopic resection of rectal cancer has been approached with caution, especially after chemoradiation, in view of the results of the MRC CLASICC trial. Two more recent trials, the COREAN trial and the COLOUR II trial, show equivalent results with laparoscopic and open resection of the rectum. We evaluated the perioperative and short term oncological results of a consecutive series of unselected patients with operable rectal cancer treated open or laparoscopic proctectomy in a one-year period.
Method All patients with rectal cancer operated at the specialist colorectal unit in the one-year period from July 2013 to June 2014 were evaluated. Patients with inoperable disease at laparoscopy/ laparotomy or those who underwent pelvic exenteration were excluded from the study. 258 consecutive unselected patients of operable rectal cancer, who underwent potentially curative resection of the rectum (laparoscopic or open) during the study period were included in the study. Data was obtained from a prospectively maintained database and analysed.
Results Eight three patients underwent laparoscopic and 175 patients underwent open resection of the tumours, depending on availability of laparosopic instruments in the operation theatre. Adenocarcinoma was the most common histology (92%). Median distance of the lower edge of the tumour from the anal verge was 5cm in both groups. The majority (87.5%) of the tumours were staged either cT3+ (74%) or cN+ (72%) or both at initial staging. Overall, 64% of patients received pre-operative radiotherapy. Mean BMI of patients was 23. The overall sphincter preservation rate was 70% (73% in open group and 64% in laparoscopic group which may be the result of a larger fraction of tumours within 5cm of the anal verge in the laparoscopic group). The overall blood loss was lower in laparoscopic group (median 200mL) than open group (median 500mL). The postoperative stay was only slightly lower in the laparoscopic group (mean 7.3 days) than open group (mean 8.4 days). CRM positivity was similar in both groups (3.6% laparoscopic versus 4% open group). Median nodal harvest was similar in both groups (12 nodes).
Conclusion Laparoscopic resection of the rectum is at least as good as open resection for rectal cancer with similar short-term oncological outcomes and improved perioperative outcomes.
Disclosure of interest None Declared.