Open versus minimally invasive surgery for rectal cancer: a single-center cohort study on 237 consecutive patients

  • Giuseppe QueroEmail author
  • Fausto Rosa
  • Riccardo Ricci
  • Claudio Fiorillo
  • Maria C. Giustiniani
  • Caterina Cina
  • Roberta Menghi
  • Giovanni B. Doglietto
  • Sergio Alfieri
Original Article


Minimally invasive surgery (MIS) is gaining popularity in rectal tumor treatment. However, contrasting data are available regarding its safety and efficacy. Our aim is to compare the open and MIS approaches for rectal cancer treatment. Two-hundred-thirty-seven patients were included: 113 open and 124 MIS rectal resections. After the propensity score matching analysis (PS), the cases were matched into 42 open and 42 MIS. Short- and long-term outcomes, and pathological findings were analyzed before and after PS. A further comparison of the same outcomes and costs was conducted between the laparoscopic and the robotic approaches. As a whole, a sphincter-preserving procedure was more frequently performed in the MIS group (110 vs 75 cases; p < 0.0001). The estimated blood loss during MIS was significantly lower than during open surgery [127 (± 92) vs 242 (± 122) mL; p < 0.0001], with clear advantages for the robotic approach over laparoscopy [113 (± 87) vs 147 (± 93) mL; p 0.01]. Complication rate was comparable between the two groups. A higher rate of CRM positivity was evidenced after open surgery (12.4% vs 1.7%; p 0.004). A higher number of lymph nodes was harvested in the MIS group [12.5 (± 6.4) vs 11 (± 5.6); p 0.04]. After PS, no difference in terms of perioperative outcomes was noted, with the only exception of a higher blood loss in the open approach [242 (± 122) vs 127 (± 92) mL; p < 0.0001]. For the matched cases, no difference in 5-year overall and disease-free survival was evidenced (p 0.50 and 0.88, respectively). Mean costs were higher for robotics as compared to laparoscopy [9812 (±1974)€ vs 9045 (± 1893)€; p 0.02]. MIS could be considered as a treatment option for rectal cancer. The PS study evidenced clear advantages in terms of estimated blood loss over the open surgery. Costs still remain the main limit for robotics.


Rectal cancer Minimally invasive Robotic proctectomy Laparoscopy 



The authors would like to thank Ms. Marion Merck, Mr. Guy Temporal, and Mr. Christopher Burel for their assistance in proofreading the manuscript.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

Giuseppe Quero, Fausto Rosa, Riccardo Ricci, Claudio Fiorillo, Maria Cristina Giustiniani, Caterina Cina, Roberta Menghi, Giovanni Battista Doglietto, Sergio Alfieri declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  • Giuseppe Quero
    • 1
    Email author
  • Fausto Rosa
    • 1
  • Riccardo Ricci
    • 2
  • Claudio Fiorillo
    • 1
  • Maria C. Giustiniani
    • 2
  • Caterina Cina
    • 1
  • Roberta Menghi
    • 1
  • Giovanni B. Doglietto
    • 1
  • Sergio Alfieri
    • 1
  1. 1.Digestive Surgery Unit of the Fondazione Policlinico “A.Gemelli”Catholic University of Sacred HeartRomeItaly
  2. 2.Department of Pathology of the Fondazione Policlinico “A.Gemelli”Catholic University of Sacred HeartRomeItaly

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