Laparoscopic and Conventional Resections for Low Rectal Cancers: A Retrospective Analysis on Perioperative Outcomes, Sphincter Preservation, and Oncological Results

Abstract

Background: This study aims to compare the results of laparoscopic and conventional techniques in patients with low rectal cancers. Subjects and Methods: A retrospective data analysis was initiated in patients underwent laparoscopic or conventional surgery for cancers located in the low (<6 cm) rectum. Patient and tumor-related information, outcomes of operations, and survival were compared between the groups. Results: Among 142 patietns (91 men [64.1%]; mean +/- standard deviation age, 57.7 +/- 14.6 years) who had tumors located <6 cm from the dentate line, 92 (64.8%) were operated on with the laparoscopic technique. Demographics, tumor stage, and localization (2.9 +/- 2.0 versus 2.9 +/- 2.1 cm from the dentate line in laparoscopic and conventional arms, respectively; P = .968) were similar. However, there were more patients in the laparoscopic group who received neoadjuvant chemoradiation therapy (92.4% versus 80.0%; P = .03), since there were significantly fewer cases with stage I tumors in this group (3.3% versus 14%; P = .33). The conversion rate was 14.1% (n = 13). The amount of bleeding and the requirement for transfusion decreased (P < .05 for both), and the possibility of sphincter-saving procedures (66.3% versus 34.0%; P < .001) increased, in the laparoscopy group. Other parameters were identical. In the laparoscopy group, the number of harvested lymph nodes (10.2 +/- 5.4 versus 12.4 +/- 6.0; P = .025) and the rate of vascular invasion (27.5% versus 47.8%; P = .021) were less, and Kaplan-Meier analysis revealed an improved survival (P = .042), although the follow-up period was significantly shorter in this group (P < .001). Conclusions: Laparoscopic surgery for low rectal cancers may be technically feasible and oncologically safe. Laparoscopy may increase the possibility of sphincter preservation.