Laparoscopic Resection of Rectal Cancer Results in Higher Lymph Node Yield and Better Short-term Outcomes Than Open Surgery: A Large Single-Center Comparative Study

BACKGROUND: Prognosis in rectal cancer is closely related to mesorectal integrity, margin status, and adequate lymph node dissection. The impact of laparoscopy on the pathologic and short-term outcomes remains controversial. OBJECTIVE: We aim to compare the pathologic and short-term outcomes of laparoscopic and open resections for rectal cancer. DESIGN: This is a large single-center retrospective comparative study using a prospective database. PATIENTS: All patients who underwent primary resections for rectal cancer from January 2007 to September 2011 were identified. MAIN OUTCOME MEASURES: Pathologic (nodal harvest, mesorectal integrity, circumferential, and distal margins) and operative outcomes were measured. RESULTS: Two hundred thirty-four (mean age, 61 years; 65% male) patients underwent resections for primary rectal cancer, including 118 laparoscopic (99 restorative proctectomies, 19 abdominoperineal resections) and 116 open (69 restorative proctectomies, 47 abdominoperineal resections) resections. Both groups were similar in demographics, comorbidities, and tumor characteristics. The laparoscopic group had significantly more lymph nodes (26 vs 21, p = 0.02) than the open group, with no differences in circumferential margins, proportion of distal resection margins <1 cm, and completeness of total mesorectal excision. The impact of laparoscopic resection on lymph nodes was also observed for restorative proctectomy (27 vs 21, p = 0.03). Furthermore, obese and laparoscopic-converted patients had equivalent pathologic outcomes for laparoscopic and open resection. Laparoscopy was associated with longer operative time (245 vs 213 minutes, p = 0.002); less blood loss (284 vs 388 mL, p = 0.01); shorter incisions (8 vs 20 cm, p = 0.0001) and hospital stay (7 vs 8 days, p = 0.05); and lower rates of 30-day morbidity (25% vs 43%, p = 0.04) and wound infections (9 vs 20%, p = 0.04). On multivariate regression, laparoscopic resection and year of surgery were the only independent predictors of greater lymph node harvest. CONCLUSIONS: Laparoscopy for primary rectal cancer is associated with a greater number of lymph nodes as well as short-term benefits.