Favorable outcomes with laparoscopic surgery for rectal cancer

Abstract

Liakakos et al. [1] concluded from a retrospective series of1,057 selected patients studied by Miyajima et al. [2] thatlaparoscopic surgery for rectal cancer is safe. Althoughcohort studies have shown safety, the most important out-comes such as disease-free survival and the recurrence rateneed to be demonstrated in prospective randomized con-trolled trials before laparoscopic surgery is accepted as thestandard approach.Laparoscopic resection of colonic cancer is proved to besafe, with no difference in long-term oncologic outcomecompared with open surgery [3–5]. However, long-termoutcome data after laparoscopic surgery for rectal cancerstill are not available.Only 5 years ago, the first study investigating the qualityof the mesorectal dissection with 25 patients was published[6]. The first randomization was done in the conventionalversus laparoscopically-assisted surgery in ColorectalCancer (CLASICC) trial with 253 patients treated withlaparoscopic surgery. The conversion rate at the beginningof the trial was 34%, which decreased to 16% during thesixth year of the study [5]. This high conversion rate in arelatively small study group was due the experience curveeffect.Miyajima et al. [2] concluded that laparoscopy is fea-sible and safe for selected patients with rectal cancer, withfavorable short- and mid-term outcomes after a mean fol-low-up period of 30 months. This retrospective study, notintended to be a comparison between open and laparo-scopic surgery, was reported without long-term outcomedata. Therefore, as stated by Liakakos et al. [1], more dataare needed from randomized controlled trials, if feasible, tosupport the hypothesis of better oncologic outcomes forclosed rather than open surgery for rectal cancer.Currently, several multicenter randomized controlledtrials comparing laparoscopic and open surgery for rectalcancer are registered (Clinicaltrials.gov) and recruitingpatients, including the laparoscopic-assisted resection oropen resection in treating patients with Stage IIA, StageIIIA, or Stage IIIB rectal cancer (NCT00726622) trial bythe American College of Surgeons (estimated primarycompletion date, August 2010) and the Phase II trial toevaluate laparoscopic surgery for Stage 0/1 rectal carci-noma (Lap RC), NCT00635466 (estimated study comple-tion date, 2016).In addition, the comparing laparoscopic and open sur-gery for rectal cancer (COLOR II) trial (NCT00297791)will fulfil the profound need for a well-designed and per-formed randomized trial. Recently, this COLOR II trialfinished randomization of 1,100 patients. The short-termresults will be presented by the colorectal cancer laparo-scopic or open resection study group on a short notice.The primary end point of the COLOR II trial is thelocoregional recurrence rate 3 years postoperatively. Untilthese data become available, we believe that open totalmesorectal excision must be regarded as the gold standardtreatment for rectal cancer.