Quality of surgery for rectal carcinoma: comparison between open and laparoscopic approaches

Abstract

Background Macroscopic evaluation of a tumor specimen is an independent prognostic factor of oncologic outcome after total mesorectal excision (TME) for rectal cancer. This study aimed to assess macroscopic quality of specimens acquired after laparoscopic versus open TME in patients with low rectal cancer. Patients and methods Seventy-two patients with low rectal cancer underwent TME either by open (n = 39) or laparoscopic (n = 33) approach. In all specimens, the cut edge of the peritoneal reflection at the anterior mid-rectum, the Denonvillier's fascia, the visceral fascia covering the mesorectum both posteriorly and laterally, and the bowel wall below the mesorectum were macroscopically assessed. Results Colorectal anastomoses were located significantly lower in the laparoscopic than in the open group ( P < .001). The Denonvillier's fascia was violated in 7 patients after open surgery ( P = .01). A significantly more complete TME with intact visceral pelvic fascia was performed after laparoscopy compared with open surgery ( P = .025). Conclusions Laparoscopy offers a macroscopically more complete specimen after TME for rectal cancer than the open approach because it offers a better view in the pelvis.