Laparoscopic vs. open total mesorectal excision in unselected patients with rectal cancer: impact on early outcome

This study was designed to compare laparoscopic vs. open total mesorectal excision for cancer of the rectum on perioperative outcome and quality of life.

A total of 187 consecutive unselected patients with rectal cancer who underwent total mesorectal excision during a seven-year period were prospectively evaluated. Patients were monitored 30 days for postoperative complications. Quality of life was evaluated before and at one year after surgery.

A total of 108 patients underwent laparoscopic total mesorectal excision, whereas 79 underwent open. Conversion rate was 12 percent. In the laparoscopic group, operating time was 33 minutes longer (P = 0.03) and intraoperative blood loss was lower (P = 0.001). Tumor stage and the number of lymph nodes that were intraoperatively collected were similar in the two groups. The overall morbidity rate was 29.6 percent in the laparoscopic and 27.8 percent in the open (P = 0.78) group. No patient died during the postoperative period. Anastomotic leak rate was similar in the two groups (14.8 percent in laparoscopic vs. 12.6 percent in open; P = 0.88). Patients in the laparoscopic group recovered earlier bowel function (P = 0.01) and experienced a shorter length of stay (P = 0.003). At one-year follow-up, overall quality of life was similar in the two groups. In the laparoscopic group, social functioning item was significantly better (P = 0.05) and trend to a better physical status was observed (P = 0.07).

Laparoscopic total mesorectal excision is safe and feasible, does not jeopardize the complication rate, and has the benefits of much less blood during the operation and shorter hospitalization.