Long-term outcomes after laparoscopic surgery versus open surgery for rectal cancer: A propensity score analysis

Background: The aim of this study was to compare the long-term outcomes of laparoscopy-assisted surgery (LAP) with those for open surgery (OS) when excising nonmetastatic rectal cancers. Methods: We reviewed the prospectively collected records of all patients (n = 1,009) undergoing OS or LAP from January 2000 to November 2008 at Kyungpook National University Hospital. We undertook propensity score analyses and compared outcomes for the OS and LAC groups in a 1:1 matched cohort. Covariates in the model for propensity scores included age, gender, preoperative tumor marker level, preoperative chemoradiation status, tumor height from the anal verge, and clinical tumor stage. Subgroup analysis was conducted to evaluate the oncologic safety of LAP in patients with extraperitoneal rectal cancers. Results: There were no significant differences in mortality, morbidity, and pathological quality in the propensity-matched cohort (n = 812). The combined 3-year local recurrence rate for all tumor stages was 3.8 % (95 % confidence intervals [95 % CI], 1.9-5.7 %) in the LAP group and 5.9 % (95 % CI, 3.9-8.3 %) in the OS group (P =.089 by log-rank test). The combined 3-year disease-free survival for all stages was 80.5 % (95 % CI, 76.6-84.4 %) in the LAP group and 82.9 % (95 % CI 79.2-86.6 %) in the OS group (P =.516 by log-rank test). Similar results were confirmed for the subgroup of patients with extraperitoneal rectal cancers. Conclusions: Laparoscopic rectal excision for rectal cancer is feasible and safe with acceptable oncologic outcomes. Further prospective multicenter trials are warranted before incorporating this technology into routine surgical care.