Laparoscopic vs. Open Surgery for Rectal Cancer

Summary and Comment |
April 1, 2015

Laparoscopic vs. Open Surgery for Rectal Cancer

  1. Henry Mark Kuerer, MD, PhD, FACS

Regional and distant recurrences at 3 years were similar with either technique.

  1. Henry Mark Kuerer, MD, PhD, FACS

Laparoscopic colon resection has become standard practice for treating patients with colon cancer because it is associated with faster recovery time and less pain compared with open surgery. But whether outcomes are similar with both techniques, specifically for rectal cancer, is unclear.

To examine this issue, international investigators conducted a noninferiority, randomized, open-label trial (COLOR II) involving 1044 patients with localized solitary rectal cancer located within 15 cm from the anal verge. Individuals with T3/4 tumors within 2 mm of endopelvic fascia were excluded. Patients were randomized 2:1 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 mesorectal and distal resection, and number of harvested lymph nodes.

At the planned 3-year analysis, no significant differences were found between the laparoscopic and open-surgery groups in terms of locoregional recurrence rate (the primary endpoint; 5% in both groups), disease-free-survival (74.8% and 70.8%, respectively), overall survival (86.7% and 83.6%), or rate of complications. Involved pathologic circumferential margins (<2 mm) were found in 10% in both groups of patients.

Comment

Although the authors state that these are “long-term” results, a 3-year endpoint is still early. Nevertheless, these findings are encouraging and indicate that recurrence and survival are not inferior with laparoscopic versus open surgery for rectal cancer. Results from the now completed ACOSOG-Z6051 trial comparing laparoscopic-assisted resection versus open resection for rectal cancer will be of interest to the oncology community.

Editor Disclosures at Time of Publication

  • Disclosures for Henry Mark Kuerer, MD, PhD, FACS at time of publication Consultant / Advisory board Lightpoint Medical, Inc Speaker's bureau Physicians’ Education Resource, LLC Royalties McGraw-Hill Professional; UpToDate, Inc Grant / Research support National Cancer Institute; Genomic Health, Inc Editorial boards Annals of Surgical Oncology Leadership positions in professional societies NRG Oncology (Institutional PI and Breast Committee); Society of Surgical Oncology (Chair, Curriculum Ad Hoc Committee, Breast Program Directors)

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