Comparison between the oncologic outcome of laparoscopic surgery and open surgery for T1 and T2 rectosigmoidal and rectal carcinoma: matched case-control study.

Background/aims: The long-term outcome of laparoscopic resection (Lap-R) of rectal cancer is still unclear. The purpose of this study was to elucidate the validity of Lap-R by comparing the short-term and mid-term outcome of Lap-R performed in our hospital to treat T1 and T2 rectal cancer patients with that of patients with the same clinicopathological background treated for rectal cancer by open surgery (O-R).

Methodology: We conducted a matched case-control study of the oncologic outcome of T1 and T2 rectal cancer patients who had undergone Lap-R between 1996 and 2002 by matching them for sex, age, location, and TNM classification with patients who underwent O-R during the same period, and the total number of subjects in both groups combined was 76.

Results: The median follow-up period in the Lap-R group was 36 months, as opposed to 58 months in the O-R group. There were no operative deaths in either group. Comparison of the postoperative complications showed that intraoperative blood loss was significantly less in the Lap-R group than in the O-R group (P < 0.0001), and there were fewer cases of intestinal obstruction (p = 0.0312). The number of postoperative hospital days was also significantly shorter (p = 0.00046). The overall survival rate was 91.6% in the Lap-R group and 92.7% in the O-R groups, and the difference was not significant (p = 0.5306). The recurrence-free survival rate was 96.7% in the Lap-R group and 82.4% in the O-R group, and the difference was not significant (p = 0.4587). The difference in recurrence rate between the groups was not significant (p = 0.446), and there were no differences in modes of recurrence, but local recurrence was the most common mode in both groups. No recurrences were observed at the site of the port in the Lap-R group.

Conclusions: When we performed our matched case-control study of Lap-R and O-R as surgical procedures for T1 and T2 rectal cancer, Lap-R was less invasive based on the short-term outcome. Moreover, there were no significant differences in mode of recurrence or recurrence rate, and no significant difference between the two groups was observed in oncologic outcome. It will be necessary to await the results of both Japanese and international randomized controlled trials (RCT). However, short- and mid-term follow-up of identical patients at a single institution as in the present study also appeared to have sufficient significance.