Laparoscopic-assisted abdominoperineal resection for low rectal cancer provides a shorter length of hospital stay while not affecting the recurrence or survival: a propensity score-matched analysis

Purpose To compare the short- and intermediate-term outcomes of open versus laparoscopic abdominoperineal resection (APR) for low rectal cancer. Methods Elective open and laparoscopic APRs were identified in a prospective database and were 1:1 propensity score-matched for age, ASA grade, tumour stage and type of neoadjuvant therapy. The short-and intermediate-term outcomes were compared. Results From January 2003 until June 2013, a total of 135 APRs (87 open, 48 laparoscopic) were identified and matched (n = 96, standardised mean difference of covariates <0.25). The thirty-day mortality, R0 rate, lymph nodes harvested and reoperations were similar. The length of the hospital stay was shorter in the laparoscopic group [10 versus 14 days, p = 0.004 (Mann-Whitney U test), Bonferroni-corrected significance level = 0.0083]. The median follow-up was 4.6 (IQR: 2.0-6.0) years. The overall and recurrence-free 3-year survival rate estimates (Kaplan-Meier method; 95 % CI in brackets) were 71 % (59-86) and 57 % (44-73) in the open group versus 78 % (66-92) and 72 % (60-87) in the laparoscopic group, respectively [p = 0.167 and p = 0.186 (log-rank test), respectively]. The 3-year cumulative incidence of recurrence was 27 % (15-40) in the open group and 16 % (8-29) in the laparoscopic group [p = 0.359 (Gray's test)]. Conclusions Compared to open APR, laparoscopic APR provided a shorter length of hospital stay while showing no intermediate-term differences in the survival or cumulative incidence of recurrence.