Related Experiment Video
Updated: Jun 12, 2026
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Comparative Oncologic Outcomes of Laparoscopic versus Open Surgery for Early-Onset Low Rectal Cancer: 3-Year Results
Yanwu Sun1, Zhenyu Xu1, Xiaojie Wang1
1Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Background:
Low rectal cancer poses unique surgical challenges due to its anatomy, complicating the balance between radical resection and functional preservation. Early-onset low rectal cancer (EO-LRC, < 50 years) adds complexity: it has distinct, more aggressive biological/clinical features but no age-stratified surgical guidelines. Moreover, laparoscopic surgery's efficacy in EO-LRC is controversial-though non-inferior in general low rectal cancer, EO-LRC's aggressiveness may offset its benefits. This study aims to compare oncologic outcomes of laparoscopic versus open surgery in EO-LRC patients.
Patients And Methods:
In this post-hoc analysis of the LASRE trial, the cohort included 240 EO-LRC and 799 late-onset low rectal cancer (LO-LRC, ≥ 50 years) patients, and were randomly assigned to open or laparoscopic resection. Primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS).
Results:
EO-LRC exhibited better ECOG performance status and lower ASA scores; however, they presented with more advanced disease and received more preoperative therapy. The operative time and blood loss were comparable. EO-LRC patients had a higher proportion of pN2 stage and poorly differentiated tumors. The total mesorectal excision quality and negative margins were similar. The 3-year OS (laparoscopic 91.3% vs. open 95.5%, p = 0.270) and DFS (laparoscopic 78.6% vs. open 76.1%, p = 0.657) were comparable between groups. Multivariate analysis identified preoperative therapy and pN classification as significant prognostic factors for DFS. No significant differences in oncologic outcomes were observed between groups.
Conclusions:
Laparoscopic TME provides non-inferior oncologic control in EO-LRC patients. The small EO-LRC sample size necessitates cautious interpretation of findings, requiring validation in larger cohorts.
