title: Critical appraisal of laparoscopic vs open rectal cancer surgery.
abstract: OBJECTIVE
  To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer.
  
  
  METHODS
  An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared.
  
  
  RESULTS
  Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin < 2 mm, and postoperative adjuvant chemotherapy. The survival benefit of laparoscopic surgery was no longer significant on multivariate analysis (P = 0.148). Neither 5-year overall survival (70.5% vs 61.8%, P = 0.217) nor 5-year cancer free survival (64.3% vs 66.6%, P = 0.854) were significantly different between the laparoscopic group and the converted group.
  
  
  CONCLUSIONS
  LRR has equivalent long-term oncologic outcomes when compared to OP. Laparoscopic conversion does not confer a worse prognosis.
authors.affiliation: Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Carol Tien Tau Loi, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169856, Singapore.
authors.forename: Winson Jianhong
authors.initials: WJ
authors.lastname: Tan
authors.affiliation: Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Carol Tien Tau Loi, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169856, Singapore.
authors.forename: Min Hoe
authors.initials: MH
authors.lastname: Chew
authors.affiliation: Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Carol Tien Tau Loi, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169856, Singapore.
authors.forename: Angela Renayanti
authors.initials: AR
authors.lastname: Dharmawan
authors.affiliation: Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Carol Tien Tau Loi, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169856, Singapore.
authors.forename: Manraj
authors.initials: M
authors.lastname: Singh
authors.affiliation: Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Carol Tien Tau Loi, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169856, Singapore.
authors.forename: Sanchalika
authors.initials: S
authors.lastname: Acharyya
authors.affiliation: Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Carol Tien Tau Loi, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169856, Singapore.
authors.forename: Carol Tien Tau
authors.initials: CT
authors.lastname: Loi
authors.affiliation: Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Carol Tien Tau Loi, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169856, Singapore.
authors.forename: Choong Leong
authors.initials: CL
authors.lastname: Tang
keywords: Conversion; Laparoscopic; Outcomes; Prognosis; Rectal cancer