title: Outcome of tumor-specific mesorectal excision for rectal cancer: the impact of laparoscopic resection.
abstract: OBJECTIVE
  The study aimed to compare the outcomes of laparoscopic and open resection for rectal cancer in 1,063 consecutive cases in a single center.
  
  
  METHODS
  We performed an analysis of 11 years of experience in rectal cancer surgery and compared the outcome of laparoscopic and open surgery. Multivariate and subgroup analysis was performed to look at the effect of the level of tumor and stage of disease on short-term outcomes like conversion rate, anastomotic leak rate, length of stay, complication rate, 30-day mortality, and long-term outcomes like local recurrence and survival.
  
  
  RESULTS
  A total of 1,063 patients underwent rectal resection with 470 (44.2%) patients undergoing the laparoscopic approach. Groups were comparable in terms of age, sex, or co-morbidities, and the operating time was longer in the laparoscopic group (210 vs. 150 min; p value < 0.001). A conversion rate of 6.8% was noted, with an anastomotic leak rate of 3.87% in the open group and 2.97% in the laparoscopic group. The laparoscopic group had a lower blood loss (100 vs. 350 ml; p < 0.001), lower complication rates, and shorter length of stay (6 vs. 9 days). The local recurrence rate was comparable, and the laparoscopic approach had better overall and cancer-specific survival, even after adjusting for stages. The laparoscopic approach was an independent factor associated with better overall and cancer-specific survival on multivariate analysis.
  
  
  CONCLUSIONS
  We confirmed the oncological safety of laparoscopic rectal cancer surgery. Laparoscopic surgery also showed superiority in the short-term and long-term outcomes of rectal cancer.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
authors.forename: Zakir K
authors.initials: ZK
authors.lastname: Mohamed
authors.forename: Wai Lun
authors.initials: WL
authors.lastname: Law
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical; D061887:Conversion to Open Surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D061646:Operative Time; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome