title: Higher risk of incomplete mesorectal excision and positive circumferential margin in low rectal cancer regardless of surgical technique.
abstract: BACKGROUND
  Currently, the predominant question is whether a laparoscopic approach is comparatively radical in comparison with an open access approach, especially in the circumferential resection margin and quality of the completeness of total mesorectal excision. These factors are important in determining the quality of surgical care as well as long-term results of the treatment.
  
  
  OBJECTIVE
  This article focuses on the evaluation of circumferential resection margins and on the quality of mesorectal excision of middle and lower rectum tumors. In addition, laparoscopic and open techniques are compared.
  
  
  METHODS
  Data were collected prospectively and stored in a rectal cancer registry over a 3-year period. The parameters studied were age, sex, body mass index, localization and topography of the tumor, clinical stage, neoadjuvant chemotherapy and its response, the type of surgery, character of the circumferential and distal margins, quality of the mesorectal excision, pT and pN.
  
  
  RESULTS
  One hundred and twenty-five patients were chosen for our study. Laparoscopy was performed in 53 operations and a conventional approach was performed in 72 operations. Complete mesorectal excision was achieved in 54.7% of laparoscopic operations versus 44.4% in the conventional technique; partially complete excision was performed in 20.8 and 12.5%, respectively. Incomplete excisions were described in 24.5 and 43.1% (p = 0.085). Positive circumferential margin occurred during laparoscopic surgery in 11 (20.8%) patients, and in the case of conventional resection in 27 (37.5%) patients (p = 0.044).
  
  
  CONCLUSIONS
  Our study showed comparable results between laparoscopic and open access procedures during rectal resection. The results achieved, in particular in the quality of the mesorectal excision and negative circumferential resection margin, show that the laparoscopic approach is comparable to conventional surgical techniques, with an adequate surgical outcome, in the treatment of rectal cancer.
authors.affiliation: Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ferko
authors.affiliation: Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic.
authors.forename: Julius
authors.initials: J
authors.lastname: Orhalmi
authors.affiliation: Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic ; Department of Military Surgery, Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Dusek
authors.affiliation: Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Chobola
authors.affiliation: The Fingerland Department of Pathology, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Hovorkova
authors.affiliation: The Fingerland Department of Pathology, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic.
authors.forename: Dimitar Hadzi
authors.initials: DH
authors.lastname: Nikolov
keywords: circumferential resection margin; colorectal cancer; total mesorectal excision