NEW YORK (Reuters Health) – A study comparing laparoscopic to open surgery for rectal cancer has confirmed the long-term oncologic safety of the laparoscopic approach.

“This pooled analysis of 3 randomized controlled trials with a follow-up of more than 10 years demonstrates that laparoscopic surgery for rectal cancer is associated with similar long-term recurrence and survival rates when compared with open surgery,” the researchers conclude.

Previously, starting in 1993, Dr. Simon S. M. Ng and colleagues at Prince of Wales Hospital and the Chinese University of Hong Kong, conducted three randomized trials comparing open surgery to various laparoscopic approaches in resecting upper, mid and lower rectal cancers.

Although the results were consistent, firm conclusions on long-term outcomes could not be determined because of the relatively small sample sizes. The team therefore pooled the data, covering 278 patients who underwent curative resection — 136 having laparoscopic procedures and 142 open surgeries — for the current study.

Median follow-up for living patients in the two groups was 124.5 and 136.6 months, respectively. There were no significant differences in outcomes, the authors report in the Annals of Surgery online April 23.

Specifically, at 10 years, locoregional recurrence rates were 5.5% versus 9.3% (p=0.296) in the laparoscopic and open groups, respectively. Corresponding rates of cancer-specific survival were 82.5% versus 77.6% (p=0.443) and overall survival was 63.0% versus 61.1% (p=0.505).

The study was also designed to look at predictors of survival, and it identified three already known risk factors for poorer cancer-specific survival: namely, stage III cancer, lymphovascular permeation, and postoperative blood transfusion. Operative method was not a predictor of survival.

Dr. Ng and colleagues note that resection margins and the number of lymph nodes removed was similar in the laparoscopic and open groups. In particular, the rate of resection margin involvement was low at 1.5% in the laparoscopic group and 1.4% in the open surgery group. They attribute this to standardized techniques performed by experienced surgeons at their center.

Given the overall findings, they conclude, “The oncologic safety of laparoscopic surgery for rectal cancer is therefore confirmed.”

SOURCE: Long-term Oncologic Outcomes of Laparoscopic Versus Open Surgery for Rectal Cancer: A Pooled Analysis of 3 Randomized Controlled Trials
Ann Surg 2013.