title: Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial.
abstract: BACKGROUND
  Laparoscopic resection of colonic cancer has been shown to improve postoperative recovery without jeopardizing tumor clearance and survival, but information on low rectal cancer is scarce. The aim of this randomized trial was to compare postoperative recovery between laparoscopic-assisted versus open abdominoperineal resection (APR) in patients with low rectal cancer. Recurrence and survival data were also recorded and compared between the two groups.
  
  
  METHODS
  Between September 1994 and February 2005, 99 patients with low rectal cancer were randomized to receive either laparoscopic-assisted (51 patients) or conventional open (48 patients) APR. The median follow-up time of living patients was about 90 months for both groups. The primary and secondary endpoints of the study were postoperative recovery and survival, respectively. Data were analyzed by intention-to-treat principle.
  
  
  RESULTS
  The demographic data of the two groups were comparable. Postoperative recovery was better after laparoscopic surgery, with earlier return of bowel function (P < .001) and mobilization (P = .005), and less analgesic requirement (P = .007). This was at the expense of longer operative time and higher direct cost. There were no differences in morbidity and operative mortality rates between the two groups. After curative resection, the probabilities of survival at 5 years of the laparoscopic-assisted and open groups were 75.2% and 76.5% respectively (P = .20). The respective probabilities of being disease-free were 78.1% and 73.6% (P = .55).
  
  
  CONCLUSIONS
  Laparoscopic-assisted APR improves postoperative recovery and seemingly does not jeopardize survival when compared with open surgery for low rectal cancer. A larger sample size is needed to fully assess oncological outcomes.
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. simonng@surgery.cuhk.edu.hk
authors.forename: Simon S M
authors.initials: SS
authors.lastname: Ng
authors.forename: Ka Lau
authors.initials: KL
authors.lastname: Leung
authors.forename: Janet F Y
authors.initials: JF
authors.lastname: Lee
authors.forename: Raymond Y C
authors.initials: RY
authors.lastname: Yiu
authors.forename: Jimmy C M
authors.initials: JC
authors.lastname: Li
authors.forename: Anthony Y B
authors.initials: AY
authors.lastname: Teoh
authors.forename: Wing Wa
authors.initials: WW
authors.lastname: Leung
mesh_terms: D000005:Abdomen / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D010502:Perineum / Q000601:surgery*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome