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[Laparoscopic versus open rectal cancer resection: oncologically equal?].

B P Müller-Stich1, G R Linke2, M Wagner3

  • 1Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. beatpeter.mueller@med.uni-heidelberg.de.

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|July 2, 2016
PubMed
Summary

Laparoscopic rectal cancer resection shows oncological equivalence to open surgery in expert hands. Further long-term data is needed, but laparoscopic approaches may be preferred due to perioperative benefits.

Keywords:
Disease-free survivalLaparoscopyLaparotomyLocal recurrenceRectal neoplasms

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Laparoscopic surgery is increasingly used for rectal cancer.
  • Its oncological safety compared to open surgery is debated.
  • Four multicenter randomized controlled trials (RCTs) have evaluated this comparison.

Purpose of the Study:

  • To evaluate the oncological equivalence of laparoscopic versus open rectal cancer resection.
  • To analyze the findings of key RCTs, including COLOR II, COREAN, ACOSOG, and ALaCaRT.

Main Methods:

  • Analysis of four multicenter RCTs comparing laparoscopic and open rectal cancer resection.
  • Focus on oncological endpoints like local recurrence and disease-free survival.
  • Critique of composite endpoints used in some studies.

Main Results:

  • COLOR II and COREAN trials demonstrated oncological equivalence.
  • ACOSOG and ALaCaRT trials reported higher success rates for open surgery using a composite endpoint, but its validity is unproven.
  • Local recurrence rates were 5% in both groups in COLOR II and COREAN, suggesting good oncological quality.

Conclusions:

  • Laparoscopic rectal resection can achieve good oncological outcomes in expert hands.
  • Long-term results from ongoing trials are necessary for final assessment.
  • If confirmed, laparoscopic resection may be preferred over open surgery due to perioperative benefits.