Laparoscopic Surgery for Rectal Cancer Helps Like "Open" Method

Minimally invasive, laparoscopic surgery for rectal cancer delivers similar long-term survival and cure rates compared to more traditional, “open” techniques, which require a much larger incision, according to an excellent new study in the New England Journal of Medicine.

In a large, multi-center prospective randomized trial, our European colleagues clearly demonstrated the well-known advantages of laparoscopic (also called keyhole) surgery, such as smaller incisions, less pain, quicker recovery and better cosmetic appearance. But outcomes of laparoscopic surgery for rectal cancer (that is, cancer within the last 6 inches of the intestinal tract) have not been well-investigated until recently.

Patients with rectal cancer were randomized two-to-one to undergo laparoscopic or open surgery. Patient characteristics were similar in both groups in terms of gender, tumor location, tumor stage, use of preoperative radiotherapy and chemotherapy, completeness of surgical resection and margins along with number of harvested lymph nodes.

In their three-year analysis, the authors found no significant differences between the laparoscopic and open-surgery groups in terms of recurrence, disease-free-survival (74.8% and 70.8%, respectively), overall survival (86.7% and 83.6%) or rate of complications. So the positive outcomes were alike between both techniques, but the laparoscopic approach adds the benefits of reduced post-operative recovery time, discomfort and scarring.

However, it’s important to remember that a group of highly trained experts in laparoscopic rectal surgery performed this study, not novice surgeons or trainees. So it appears that laparoscopic surgery for rectal cancer is a reasonable option when an expert laparoscopic colorectal and oncologist surgeon performs it. My textbook, Minimally Invasive Approaches to Colon and Rectal Disease: Technique and Best Practices (Springer Science 2015) emphasizes the proper equipment, set-up and techniques needed for successful laparoscopic rectal cancer surgery.

The book also covers robotic surgery for rectal cancer, which uses many laparoscopic methods via robotic technology. Some surgeons feel that robotic surgery may offer advantages over conventional laparoscopic surgery for rectal cancer and will become more prevalent in the future. ROLAR (Robotic Laparoscopic Rectal Cancer Study), a combined randomized trial comparing laparoscopic to robotic surgery, is underway in the US and the United Kingdom. My colleagues and I eagerly await the ROLAR study results.

Screening and early detection save lives. Learn about your risk factors for colon and rectal cancer to discuss with your physician. The North Shore-LIJ Cancer Institute offers a multidisciplinary team of colorectal cancer experts and a range of screening, diagnosis and treatment options.

This post was written by David Rivadeneira, MD, colon/rectal surgeon at the North Shore-LIJ Health System.

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