title: Long-term oncologic outcomes of laparoscopic versus open surgery for rectal cancer: a pooled analysis of 3 randomized controlled trials.
abstract: OBJECTIVE
  To compare long-term oncologic outcomes between laparoscopic and open surgery for rectal cancer and to identify independent predictors of survival.
  
  
  BACKGROUND
  Few randomized trials comparing laparoscopic and open surgery for rectal cancer have reported long-term survival data.
  
  
  METHODS
  Data from the 3 randomized controlled trials comparing curative laparoscopic (n=136) and open surgery (n=142) for upper, mid, and low rectal cancer conducted at the Prince of Wales Hospital, Hong Kong, between September 1993 and August 2007 were pooled together for this analysis. Survival and disease status were updated to February 2012. Survival was calculated using the Kaplan-Meier method, and independent predictors of survival were determined using the Cox regression analysis.
  
  
  RESULTS
  The demographic data of the 2 groups were comparable. The median follow-up time of living patients was 124.5 months in the laparoscopic group and 136.6 months in the open group. At 10 years, there were no significant differences in locoregional recurrence (5.5% vs. 9.3%; P=0.296), cancer-specific survival (82.5% vs. 77.6%; P=0.443), and overall survival (63.0% vs. 61.1%; P=0.505) between the laparoscopic and open groups. There was a trend toward lower recurrence rate at 10 years in the laparoscopic group than in the open group among patients with stage III cancer (P=0.078). The Cox regression analysis showed that stage III cancer, lymphovascular permeation, and blood transfusion, but not the operative approach, were independent predictors of poorer cancer-specific survival.
  
  
  CONCLUSIONS
  This pooled analysis with a follow-up of more than 10 years confirms the long-term oncologic safety of laparoscopic surgery for rectal cancer.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
authors.forename: Simon S M
authors.initials: SS
authors.lastname: Ng
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
authors.forename: Tony W C
authors.initials: TW
authors.lastname: Mak
authors.forename: Wing Wa
authors.initials: WW
authors.lastname: Leung
authors.forename: Ka Lau
authors.initials: KL
authors.lastname: Leung
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome