The Comparative Analysis Of Short-term Outcomes And Safety Between Laparoscopic Resection Of Rectal Cancer And Open Surgery

Objective：We aim to investigate the short-term outcomes andsurgical safety of laparoscopic resection of rectal cancer and itsadvantages over traditional open surgery.Materials and methods：A retrospective analysis of355patientswho underwent primary resections for rectal cancer from October2011toMarch2014in the Colorectal Surgery department of China Japan UnionHospital of Jilin University. Three hundred fifty-five (mean age60years;61.4%male) patients underwent resections for rectal cancer, including103open (81restorative proctectomies, and22abdominoperinealresections) and252laparoscopic (188restorative proctectomies, and64abdominoperineal resections).Both groups were similar in preoperative preparation, underwentgeneral anesthesia and endotracheal intubation, and strictly in accordancewith total mesorectal excision (TME) standards and the principles ofnon-tumor surgery. Surgery instruments were applied in the same factoryin the same batch, and the surgical specimens were fixed by formalinwithin half an hour after resection. The samples were sent to aprofessional pathology laboratory, then sliced, observed and diagnosed byprofessional pathologists. We investigated the pathology results, intraoperative situation and postoperative recovery, evaluated theadvantages and disadvantages of laparoscopic resection of rectal cancerin contrast with open surgery.Results：Both groups were similar in demographics, preoperativecomplications and tumor characteristics. Two groups of patients had nosignificant differences in age, gender, anesthesia grade, history ofprevious abdominal surgery, preoperative comorbidities, tumor stage,tumor diameter，BMI.The two groups had no significant differences in the length ofsurgical specimens, distal resection margins, or lymph node harvest.Laparoscopy was associated with longer operative time (198.532±55.769vs161.408±43.821minutes, p=0.002), lower intraoperativeblood transfusion rates (0%vs2.78%, p=0.001), less postoperative fluiddrainage volume within two days (136.367±111.083ml vs167.039±127.778ml, p=0.025), shorter postoperative intestinal function recoverytime (3.682±1.098days vs4.379±1.449days, p<0.001), lower rates of30-day morbidity (6.35%vs15.34%, p=0.006), lower rates of poorwound healing (9.52%vs17.48%, p=0.035), shorter postoperativehospital stay (14.250±4.780days vs16.757±7.365days, p p<0.001).The two groups had no significant differences in the proportion ofpostoperative pain medication use （9.52%vs11.65%, p=0.547）andproportion of preventive colostomy of patients who underwent restorative proctectomy (22.99%vs19.75%, p=0.556).Conclusion：1、The laparoscopic resection of rectal cancer and open surgery weresimilar in pathology results.2、The laparoscopic resection of rectal cancer had a better short-termoutcomes than open surgery.3、The laparoscopic resection of rectal cancer and open surgery hadthe same safety.