Outcomes Following Surgery for Distal Rectal Cancers: A Comparison between Laparoscopic and Open Abdomino-Perineal Resection.

PURPOSE Oncologic outcomes following laparoscopic abdomino-perineal resection (APR) for distal rectal cancer are infrequently reported. This study aims to compare the long term outcomes between laparoscopic and open APR in distal rectal cancers. METHODS A retrospective review of all patients who underwent APR for distal rectal cancer from May 2001 to November 2009 was performed. RESULTS Forty-two patients, median age 60 (24 - 86) years, formed the study group. Laparoscopic resection was attempted in 16 patients and was successful in all but one. Patients with recurrent diseases, previous abdominal operations and neoadjuvant chemoradiation were more likely to undergo open APR. There were no differences in the T-staging, number of lymph nodes harvested or the final stage of the disease between the two groups. The laparoscopic APR group had a shorter median length of hospitalization (7 vs. 10 days, p < 0.05), but longer operative duration (300 vs. 240 minutes, p > 0.05). Excluding the 9 (21.4%) patients with metastatic disease on presentation, 13 (39.4%) developed recurrence after a median follow up of 24 (4 - 107) months. Twenty (47.6%) patients died from their advanced disease subsequently while one (2.4%) died from a noncancer related cause. Analysis showed that tumour stage and circumferential resection margin positivity were associated with a poorer survival. The types of approach had no significant impact on the survival. CONCLUSION Laparoscopic APR for distal rectal cancer yields similar oncologic outcomes as open APR. Long-term outcome is determined by the tumour stage and circumferential resection margin and not the approach.