[Oncologic safety of laparoscopic surgery in radical resection for different stage rectal cancer]

To evaluate the oncologic safety and short-term outcomes of laparoscopic surgery in early and advanced rectal cancers.

Clinical and follow-up data of 186 cases with rectal cancer undergoing laparoscopic radical resection from June 2009 to December 2013 were analyzed retrospectively, including 48 early rectal cancer (stage 0-I) and 138 advanced cancer (stage II-III). Thirty-seven cases with early rectal cancer and 275 with advanced cancer undergoing open radical surgery were selected as control group. Surgical safety, oncologic safety and short-term outcomes were compared between two groups.

As for either early or advanced rectal cancer, there were no significant differences in the number of harvested lymph nodes, length of distal resection margin, complication morbidity, rate of local recurrence, distant metastasis, and 3-year survival rate between the two groups (all P>0.05). Although the operation time was longer in laparoscopic group, the laparoscopic group presented less intra-operative blood loss, faster recovery of bowel function, and shorter postoperative hospital stay (all P<0.05). As for advanced rectal cancer, laparoscopic radical surgery tended to achieve less lymph nodes dissected (mean, 13.5 vs. 15.0) and develop more anastomotic leakage (8.0% vs. 5.5%) compared to open surgery, although neither reached statistical significance (P=0.112, P=0.221). Moreover, the conversion rate in patients with advanced rectal cancer was significantly higher than that in those with early cancer (10.9% vs 2.1%, P=0.048).

Laparoscopic surgery can obtain the same oncologic and surgical safety for early rectal cancer as compared to open surgery. However, due to higher conversion rate, potential risk of decreased number of harvested lymph nodes and increased anastomotic leakage, laparoscopic surgery for advanced rectal cancer should be carried out prudently, especially in some hospitals with less laparoscopic experience.