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Comparison of Laparoscopic vs. Open Access Surgery in Patients with Rectal Cancer: A Prospective Analysis

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Diseases of the Colon & Rectum



Laparoscopic surgery of colon cancer has been accepted to be oncologically adequate compared with open resection. However, the situation in rectal cancer remains unclear, because anatomy and complex surgical procedures might specifically influence the long-term outcome. This study was designed to analyze perioperative and long-term outcome of patients with rectal cancer after laparoscopic vs. open access surgery.


A total of 389 patients (1998–2005) were prospectively analyzed; 114 patients had laparoscopic beginning, and 25 patients had conversion and were separately analyzed. Eighty-nine patients remained in the laparoscopic group and 275 had open access surgery.


Both groups were comparable regarding age, gender, tumor localization, stage, and complications. Differences were found in harvested lymph nodes (laparoscopic 13.5/open access 16.9; P = 0.001) and hospitalization (15.1/18.7 days; P = 0.037). Local recurrence rate and metachronous metastasis were comparable. In patients with deep anterior resection with total mesenteric excision, favorable long-term survival in the laparoscopic group was found (P = 0.035, log-rank).


Minimally invasive surgery is equivalent in the treatment of rectal cancer and shows advantages of shorter hospitalization and faster recovery. Especially in patients with low rectal cancer, minimally invasive surgery with exact preparation of the total mesenteric excision seems to be favorable compared with open access surgery.

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  1. Fitzgibbons RJ Jr, Puri V. Laparoscopic inguinal hernia repair. Am Surg 2006;72:197–206.

    PubMed  Google Scholar 

  2. Shamiyeh A, Wayand W. Current status of laparoscopic therapy of cholecystolithiasis and common bile duct stones. Dig Dis 2005;23:119–26.

    Article  PubMed  Google Scholar 

  3. Patel NA, Bergamaschi R. Laparoscopy for diverticulitis. Semin Laparosc Surg 2003;10:177–83.

    PubMed  Google Scholar 

  4. Uranues S, Alimoglu O. Laparoscopic surgery of the spleen. Surg Clin North Am 2005;85:75–90, ix.

    Article  PubMed  Google Scholar 

  5. Guillou PJ, Quirke P, Thorpe H, 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;365:1718–26.

    Article  PubMed  Google Scholar 

  6. Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005;6:477–84.

    Article  PubMed  Google Scholar 

  7. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–9.

    Article  Google Scholar 

  8. Marescaux J, Rubino F, Leroy J. Laparoscopic total mesorectal excision for rectal cancer surgery. Dig Dis 2005;23:135–41.

    Article  PubMed  Google Scholar 

  9. Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW. Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 2003;46:1047–53.

    Article  PubMed  Google Scholar 

  10. Wichmann MW, Huttl TP, Winter H, et al. Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study. Arch Surg 2005;140:692–7.

    Article  PubMed  Google Scholar 

  11. Whelan RL, Franklin M, Holubar SD, et al. Postoperative cell mediated immune response is better preserved after laparoscopic vs. open colorectal resection in humans. Surg Endosc 2003;17:972–8.

    Article  PubMed  CAS  Google Scholar 

  12. Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004;363:1187–92.

    Article  PubMed  Google Scholar 

  13. Breukink SO, Grond AJ, Pierie JP, Hoff C, Wiggers T, Meijerink WJ. Laparoscopic vs. open total mesorectal excision for rectal cancer: an evaluation of the mesorectum’s macroscopic quality. Surg Endosc 2005;19:307–10.

    Article  PubMed  CAS  Google Scholar 

  14. Bretagnol F, Lelong B, Laurent C, et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 2005;19:892–6.

    Article  PubMed  CAS  Google Scholar 

  15. Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 2004;18:281–9.

    Article  PubMed  CAS  Google Scholar 

  16. Breukink S, Pierie J, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 2006;CD005200.

  17. Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002;359:2224–9.

    Article  PubMed  Google Scholar 

  18. Morino M, Parini U, Giraudo G, Salval M, Brachet CR, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 2003;237:335–42.

    Article  PubMed  Google Scholar 

  19. Feliciotti F, Guerrieri M, Paganini AM, et al. Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 2003;17:1530–5.

    Article  PubMed  CAS  Google Scholar 

  20. Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994;81:1224–6.

    Article  PubMed  CAS  Google Scholar 

  21. Gervaz P, Pikarsky A, Utech M, et al. Converted laparoscopic colorectal surgery. Surg Endosc 2001;15:827–32.

    Article  PubMed  CAS  Google Scholar 

  22. Gonzalez R, Smith CD, Mason E, et al. Consequences of conversion in laparoscopic colorectal surgery. Dis Colon Rectum 2006;49:197–204.

    Article  PubMed  Google Scholar 

  23. Tekkis PP, Senagore AJ, Delaney CP. Conversion rates in laparoscopic colorectal surgery: a predictive model with, 1253 patients. Surg Endosc 2005;19:47–54.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Markus M. Heiss M.D..

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Ströhlein, M.A., Grützner, KU., Jauch, KW. et al. Comparison of Laparoscopic vs. Open Access Surgery in Patients with Rectal Cancer: A Prospective Analysis. Dis Colon Rectum 51, 385–391 (2008).

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