Laparoscopic Surgery Yielded Safety, Outcomes Comparable to Open Surgery for Patients With Low Rectal Cancer

In a randomized clinical trial, laparoscopic surgery proved to be safe and provide pathologic outcomes that were comparable to open surgery for patients with low rectal cancer, while providing higher sphincter preservation rates, and favorable postoperative recovery.

Laparoscopic surgery has recently become more popular in the treatment of rectal cancer however, study authors wrote, “it remains challenging to achieve oncological outcomes equivalent to open surgery, particularly for low rectal cancer.” Previous trials comparing the two methods have presented conflicting results.

The Laparoscopy-Assisted Surgery for Carcinoma of the Low Rectum (LASRE) trial enrolled 1039 patients from 22 tertiary hospitals across China between November 2013 and June 2018. Patients were randomized on a 2:1 basis to receive either laparoscopic surgery (n = 685) or open surgery (n = 354) for low rectal cancer. The primary end point of 3-year disease-free survival will be reported at a later date, as data is not yet available. The current report shares short-term pathologic and surgical outcomes.

The rate of complete mesorectal excision was 85.3% in the laparoscopic surgery group, compared to 85.8% in the open surgery group (difference, -0.5%; 95% CI, -5.1% to 4.5%; P = .78). There were no significant differences between the laparoscopic group and the open surgery group when it came to rates of negative circumferential and distal resection margins, and number of retrieved lymph nodes.

Laparoscopic surgery had a longer operating time and lower estimated intraoperative blood compared to open surgery. In the laparoscopic group, 1.8% of patients experienced an intraoperative complication, compared to 2.0% in the open surgery group. The rate of sphincter preservation was higher in the laparoscopic group at 71.7%, compared to 65.0% in the open surgery group (difference, 6.7%; 95% CI, -0.8 to 12.7; P = .09).

Laparoscopic surgery had more favorable postoperative outcomes including less time to first flatus, less time to first defecation, shorter duration of analgesic use, and shorter duration of hospitalization. In terms of postoperative complications, there was no significant difference in the rates between the laparoscopic group and open surgery group. The rate of severe postoperative complications was 0.7% in the laparoscopic group compared to 2.0% in the open surgery group (difference, -1.2%; 95% CI, -3.3% to 0.2%; P = .07). There were no deaths within 30 days of the surgery in either group.

The study authors concluded, “Laparoscopic surgery for low rectal surgery, when performed by experience surgeons, could yield pathologic outcomes comparable to those of open surgery in terms of complete mesorectal excision and negative resection margins, with a higher sphincter preservation rate and favorable postoperative recovery. Long-term oncological outcomes are currently being evaluated and will be addressed in further studies.”

Source:

Jiang WZ, Xu JM, Xing JD, et al. Short-term outcomes of laparoscopy-assisted vs open-surgery for patients with low rectal cancer: The LASRE randomized clinical trial. JAMA Oncol. Published online September 15, 2022. doi: 10.1001/jamaoncol.2022.4079