Minimally invasive versus open total mesorectal excision for rectal cancer: Long-term results from a case-matched study of 633 patients.
BACKGROUND
This study compared the long-term oncologic outcomes of patients with rectal cancer who underwent either laparoscopic or robotic total mesorectal excision (TME) via minimally invasive surgery (MIS) to those patient who underwent open TME.


METHODS
This study was a retrospective, case-control study; patients in the 2 groups were matched according to age, sex, MIS vs open operation, body mass index, tumor location, pathologic TNM stage (ie, tumor-node-metastasis), neoadjuvant treatment, and adjuvant treatment.


RESULTS
A total of 633 patients (MIS, n = 211; open, n = 422) were assessed. The median follow-up period was 64 (2-124) months. Patient characteristics did not differ between the groups. Overall postoperative complication rates did not differ between the groups (16.0% [MIS]; 17.0% [open]; P = .76). Rates of the involvement of the circumferential resection margin did not differ between the groups (4.0% [MIS]; 5.0% [open]; P = .84). The 5-year overall survival, disease-specific survival, disease-free survival, and local recurrence rates were not different between the MIS and open groups (overall survival = 88.4% vs 85.3%, P = .23; disease-specific survival = 88.8% vs 87.4%, P = .53, disease-free survival = 80.7% vs 78.4%, P = .74; local recurrence = 5.7% vs 5.1%, P = .95). In subgroup analysis, no differences were found in terms of the long-term, oncologic outcomes, oncologic adequacy, and postoperative complications among 3 groups.


CONCLUSIONS
We found no differences in the oncologic outcomes between MIS and open surgery, suggesting that MIS for rectal cancer is a safe option for rectal cancer that does not increase the risk of serious complications.
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Min Soo
MS
Cho
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Chang Woo
CW
Kim
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Se Jin
SJ
Baek
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Hyuk
H
Hur
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Byung Soh
BS
Min
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Seung Hyuk
SH
Baik
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Kang Young
KY
Lee
Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. Electronic address: namkyuk@yuhs.ac.
Nam Kyu
NK
Kim
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016022:Case-Control Studies; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D011351:Proctoscopy / Q000379:methods* / Q000401:mortality; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D065287:Robotic Surgical Procedures / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome