Surgical Endoscopy

, Volume 27, Issue 1, pp 295–302 | Cite as

Laparoscopic versus open surgery for rectal cancer: results of a prospective multicentre analysis of 4,970 patients

  • J. Lujan
  • G. Valero
  • S. Biondo
  • E. Espin
  • P. Parrilla
  • H. Ortiz



To compare laparoscopic versus open surgery for rectal cancer and analyse the results of the multidisciplinary audited project on total mesorectal excision conducted in Spain.


The safety and therapeutic efficiency of laparoscopic surgery for rectal cancer are controversial due to the technical difficulties it involves. A deviation from the oncological principles of mesorectal excision would mean a potential increase in local recurrence and shorter survival.


This prospective non-randomised multicentre study includes 4,970 patients with rectal cancer. The study compares perioperative, postoperative, anatomicopathological and survival variables.


Five hundred and sixty five patients were excluded. Of the remaining 4,405, 3,018 (68.51 %) had open surgery (OS) and 1,387 (31.49 %) laparoscopic surgery (LS). The rate of anterior resections was higher in the LS group. The rate of intraoperative tumour perforation, number of red blood cell concentrates transfused and length of hospital stay were greater in the OS group, whereas surgical time was longer in the LS group. The incidence of complications was 45.6 % in the OS group and 38.3 % in the LS group. Involvement of the circumferential and distal margin, as well as unsatisfactory and partially satisfactory quality of the mesorectum, were greater in the OS group. There were no differences for local recurrence and survival rates.


According to these results, laparoscopic surgery is the best option for the surgical treatment of rectal cancer, with similar rates of local recurrence and survival, although there are oncological indicators in this study to suggest that these results can be improved with laparoscopic surgery.


Rectal cancer Total mesorectal excision Laparoscopic surgery 



The authors are grateful to the participating hospitals and specialists of the Spanish Rectal Cancer Project 2006–2010.


The authors have no conflicts of interests or financial ties to declare.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • J. Lujan
    • 1
  • G. Valero
    • 2
  • S. Biondo
    • 3
  • E. Espin
    • 4
  • P. Parrilla
    • 1
  • H. Ortiz
    • 5
  1. 1.Department of SurgeryVirgen de la Arrixaca University HospitalMurciaSpain
  2. 2.Department of SurgeryMorales Meseguer University HospitalMurciaSpain
  3. 3.Department of SurgeryBellvitge University HospitalBarcelonaSpain
  4. 4.Department of SurgeryVall d’Hebron University HospitalBarcelonaSpain
  5. 5.Department of SurgeryVirgen del Camino Hospital, Public University of NavarrePamplonaSpain

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