title: Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial.
abstract: OBJECTIVE
  We have previously reported the five-year results of a randomized trial comparing laparoscopic and open resection for cancer of the upper rectum and rectosigmoid junction. The aim of this follow-up study is to report on the long-term morbidity and ten-year oncologic outcomes among the subgroup of patients with upper rectal cancer.
  
  
  METHODS
  From September 1993 to October 2002, 153 patients with upper rectal cancer were randomly assigned to receive either laparoscopic-assisted (n = 76) or open (n = 77) anterior resection. Patients were last followed up in December 2007. Long-term morbidity, survival, and disease-free interval were prospectively recorded. Data were analyzed by intention-to-treat principle.
  
  
  RESULTS
  The demographic data of the two groups were comparable. More patients in the open group developed adhesion-related bowel obstruction requiring hospitalization (P = 0.001) and intervention. The overall long-term morbidity rate was also significantly higher in the open group (P = 0.012). After curative resection, the probabilities of cancer-specific survival at ten years of the laparoscopic-assisted and open groups were 83.5 percent and 78.0 percent, respectively (P = 0.595), and their probabilities of being disease-free at ten years were 82.9 percent and 80.4 percent, respectively (P = 0.698).
  
  
  CONCLUSIONS
  Laparoscopic-assisted anterior resection for upper rectal cancer is associated with fewer long-term complications and similar ten-year oncologic outcomes when compared with open surgery.
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: Sophie S F
authors.initials: SS
authors.lastname: Hon
mesh_terms: D000368:Aged; D002423:Cause of Death; D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome