Laparoscopic versus open total mesorectal excision in rectal cancers: a randomized-controlled trial

Abstract

Background Laparoscopic total mesorectal excision (lap TME) is a widely used approach for rectal cancers, but sometimes, it faces some challenges especially in obese patients with low rectal tumors and after chemoradiation. Some trials proved noninferiority of lap TME, whereas others failed, and much debate exists. Purpose This study was designed to compare the pathologic outcomes of laparoscopic and open TME regarding distal resection margin and circumferential resection margin. It also aimed to compare the operative and recovery data, in addition to the intraoperative and postoperative complication. Patients and methods We prospectively reviewed the medical records of 120 patients who underwent TME between February 2017 and February 2019. Cases were selected randomly using a closed envelope for the first admitted 120 patients. Patients were divided into two groups: laparoscopic and open groups. Results Each group had 60 patients with similar characteristics. Both groups revealed similar pathologic outcomes; circumferential resection margin was involved three (5.0%) in laparoscopic TME group versus five (8.33%) in open TME, with P value of 0.464. TME quality was complete or near complete in 57 (95.0%) in laparoscopic group versus 54 (90.0%) in open group, with P value of 0.298. Our trial revealed that laparoscopic TME had earlier recovery and shorter hospital stay compared with the open approach. Overall complications were similar: 19 (31.67%) in laparoscopic TME versus 25 (41.67%) in open TME (P=0.256); however, the blood loss and wound infection were higher in the open group. Conclusion Laparoscopic TME improves postoperative recovery, achieves similar morbidity rates, and seemingly does not jeopardize the short-term oncological parameters compared with open surgery. However, further trials are still required.