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Surgery Blog for Surgeons

Laparoscopic vs. Open Resection in Rectal Cancer


Open low anterior resection (LAR) and abdomino-perineal resections (APR) are not easy procedures, esp. in tight male pelvises. The laparoscopic approach gave us a tool dramatically improving the exposure and making the whole mesorectal excision significantly easier. As frequently in situations like that, we were quite hopeful (and meanwhile biased towards believeing) that the advantages in the laparoscopic LAR and APR would translate in better oncological outcomes.

Dr. Fleshman (Dallas, Texas) was one of the most vocal proponents of the laparoscopic approach and wanted to prove it. He recently published a very well designed study:

Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes
The ACOSOG Z6051 Randomized Clinical Trial

Using the same protocol, another study was published in the same issue of JAMA by Dr. Stevenson from Brisbane, Australia:

Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer
The ALaCaRT Randomized Clinical Trial

Both studies show that the laparoscopic approach is inferior to the open one in terms of:

  • composite of circumferential radial margin greater than 1 mm,
  • distal margin without tumor, and
  • completeness of total mesorectal excision.

Both Dr. Fleshman and Dr. Stevenson presented their studies on Monday, May 2, 2016 at the ASCRS Annual Scientific Meeting.

Dr. Fleshman was kind enough to agree giving an interview with BTK.