Journal of Gastrointestinal Surgery

, Volume 19, Issue 1, pp 124–132 | Cite as

Laparoscopic Versus Open Low Anterior Resection for Rectal Cancer: Results from the National Cancer Data Base

  • Daniel P. Nussbaum
  • Paul J. Speicher
  • Asvin M. Ganapathi
  • Brian R. Englum
  • Jeffrey E. Keenan
  • Christopher R. Mantyh
  • John Migaly
2014 SSAT Plenary Presentation



While the use of laparoscopy has increased among patients undergoing colorectal surgery, there is ongoing debate regarding the oncologic equivalence of laparoscopy compared to open low anterior resection (LAR) for rectal cancer.


The 2010–2011 NCDB was queried for patients undergoing LAR for rectal cancer. Subjects were grouped by laparoscopic (LLAR) versus open (OLAR) technique. Baseline characteristics were compared. Subjects were propensity matched, and outcomes were compared between groups.


A total of 18,765 patients were identified (34.3 % LLAR, 65.7 % OLAR). After propensity matching, all baseline variables were highly similar except for carcinoembryonic antigen (CEA) level. Complete resection was more common in patients undergoing LLAR (91.6 vs. 88.9 %, p < 0.001), and statistically significant benefits were observed for gross, microscopic, and circumferential (>1 mm) margins (all p < 0.001). There was no difference in median number of lymph nodes obtained (15 vs. 15). Patients undergoing LLAR had shorter lengths of stay (5 vs. 6 days, p < 0.001) without a corresponding increase in 30-day readmission rates (6 vs. 7 %, p = 0.02).


Laparoscopic LAR appears to result in equivalent short-term oncologic outcomes compared to the traditional open approach as measured via surrogate endpoints in the NCDB. While these results support the increasing use of laparoscopy in rectal surgery, further data are necessary to assess long-term outcomes.


Laparoscopy Low anterior resection Rectal cancer Colorectal surgery National Cancer Data Base 



Departmental funds


  1. 1.
    ACS. Colorectal Cancer Facts & Figures Atlanta, Georgia2014 [April 9, 2014]. Available from:
  2. 2.
    Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. The New England journal of medicine. 2006 Sep 14;355(11):1114-23. PubMed PMID: 16971718.Google Scholar
  3. 3.
    Camma C, Giunta M, Fiorica F, Pagliaro L, Craxi A, Cottone M. Preoperative radiotherapy for resectable rectal cancer: A meta-analysis. JAMA : the journal of the American Medical Association. 2000 Aug 23-30;284(8):1008-15. PubMed PMID: 10944647.Google Scholar
  4. 4.
    Bosset JF, Calais G, Mineur L, Maingon P, Stojanovic-Rundic S, Bensadoun RJ, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. The lancet oncology. 2014 Feb;15(2):184-90. PubMed PMID: 24440473.Google Scholar
  5. 5.
    Baik SH, Gincherman M, Mutch MG, Birnbaum EH, Fleshman JW. Laparoscopic vs open resection for patients with rectal cancer: comparison of perioperative outcomes and long-term survival. Diseases of the colon and rectum. 2011 Jan;54(1):6-14. PubMed PMID: 21160307.Google Scholar
  6. 6.
    van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. The lancet oncology. 2013 Mar;14(3):210-8. PubMed PMID: 23395398.Google Scholar
  7. 7.
    Bilimoria KY, Bentrem DJ, Nelson H, Stryker SJ, Stewart AK, Soper NJ, et al. Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States. Archives of surgery. 2008 Sep;143(9):832-9; discussion 9-40. PubMed PMID: 18794419.Google Scholar
  8. 8.
    Speicher PJ, Englum BR, Jiang B, Pietrobon R, Mantyh CR, Migaly J. The impact of laparoscopic versus open approach on reoperation rate after segmental colectomy: a propensity analysis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2014 Feb;18(2):378-84. PubMed PMID: 23897083.Google Scholar
  9. 9.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005 May 14-20;365(9472):1718-26. PubMed PMID: 15894098.Google Scholar
  10. 10.
    Colon Cancer Laparoscopic or Open Resection Study G, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. The lancet oncology. 2009 Jan;10(1):44-52. PubMed PMID: 19071061.Google Scholar
  11. 11.
    Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW, Jr., et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Annals of surgery. 2007 Oct;246(4):655-62; discussion 62-4. PubMed PMID: 17893502.Google Scholar
  12. 12.
    Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, et al. Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Annals of surgery. 2012 Dec;256(6):915-9. PubMed PMID: 23154392.Google Scholar
  13. 13.
    Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V. Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Diseases of the colon and rectum. 2007 Apr;50(4):464-71. PubMed PMID: 17195085.Google Scholar
  14. 14.
    Feliciotti F, Guerrieri M, Paganini AM, De Sanctis A, Campagnacci R, Perretta S, et al. Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surgical endoscopy. 2003 Oct;17(10):1530-5. PubMed PMID: 12874687.Google Scholar
  15. 15.
    Law WL, Lee YM, Choi HK, Seto CL, Ho JW. Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Diseases of the colon and rectum. 2006 Aug;49(8):1108-15. PubMed PMID: 16763756.Google Scholar
  16. 16.
    NCDB. American College of Surgeons: Cancer Programs: National Cancer Data Base (NCDB) 2013. Available from:
  17. 17.
    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004 Apr 10;363(9416):1187-92. PubMed PMID: 15081650.Google Scholar
  18. 18. Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer 2013 [April 9, 2014]. Available from:
  19. 19.
    Krane MK, Fichera A. Laparoscopic rectal cancer surgery: where do we stand? World journal of gastroenterology : WJG. 2012 Dec 14;18(46):6747-55. PubMed PMID: 23239912. Pubmed Central PMCID: 3520163.Google Scholar
  20. 20.
    Nandakumar G, Fleshman JW. Laparoscopy for rectal cancer. Surgical oncology clinics of North America. 2010 Oct;19(4):793-802. PubMed PMID: 20883954.Google Scholar
  21. 21.
    Kim CW, Yoon YS, Park IJ, Lim SB, Yu CS, Kim JC. Elevation of preoperative s-CEA concentration in stage IIA colorectal cancer can also be a high risk factor for stage II patients. Annals of surgical oncology. 2013 Sep;20(9):2914-20. PubMed PMID: 23760586.Google Scholar
  22. 22.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002 Jun 29;359(9325):2224-9. PubMed PMID: 12103285.Google Scholar
  23. 23.
    Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. Journal of the American College of Surgeons. 1998 Jul;187(1):46-54; discussion -5. PubMed PMID: 9660024.Google Scholar
  24. 24.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. The lancet oncology. 2005 Jul;6(7):477-84. PubMed PMID: 15992696.Google Scholar
  25. 25.
    Clinical Outcomes of Surgical Therapy Study G. A comparison of laparoscopically assisted and open colectomy for colon cancer. The New England journal of medicine. 2004 May 13;350(20):2050-9. PubMed PMID: 15141043.Google Scholar
  26. 26.
    Mamidanna R, Burns EM, Bottle A, Aylin P, Stonell C, Hanna GB, et al. Reduced risk of medical morbidity and mortality in patients selected for laparoscopic colorectal resection in England: a population-based study. Archives of surgery. 2012 Mar;147(3):219-27. PubMed PMID: 22106248.Google Scholar
  27. 27.
    Kemp JA, Finlayson SR. Outcomes of laparoscopic and open colectomy: a national population-based comparison. Surgical innovation. 2008 Dec;15(4):277-83. PubMed PMID: 19036732.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Daniel P. Nussbaum
    • 1
  • Paul J. Speicher
    • 1
  • Asvin M. Ganapathi
    • 1
  • Brian R. Englum
    • 1
  • Jeffrey E. Keenan
    • 1
  • Christopher R. Mantyh
    • 1
  • John Migaly
    • 1
  1. 1.Department of SurgeryDuke UniversityDurhamUSA

Personalised recommendations