Laparoscopic Surgery Non-Inferior to Open Surgery for Low Rectal Cancer, reports research

Low rectal cancer is a challenging disease to treat because of its anatomical location and high risk of recurrence. Although laparoscopic surgery reduces recovery time and postoperative pain, the long-term oncologic outcome has been a controversy, especially in cases of low rectal cancer. This study compared 3-year disease-free survival and overall survival of laparoscopic versus open surgery for low rectal cancer.

The study included 1,070 patients aged 18–75 years with histologically confirmed low rectal adenocarcinoma within 5 cm from the dentate line. Patients were randomly assigned in a 2:1 ratio to either laparoscopic surgery (685 patients) or open surgery (354 patients). Participants were stratified according to the clinical stage, age, sex, BMI, and ASA classification. The main outcome measure of interest was 3-year disease-free survival, defined as locoregional recurrence, distant metastasis, or death.

Key findings of the study were as follows:

3-Year Disease-Free Survival:

• Laparoscopic surgery: 81.4% (95% CI 78.2 to 84.1).

• Open surgery: 79.8% (95% CI 75.2 to 83.6).

• HR: 0.92 (95% CI 0.69 to 1.23; p = 0.56).

• Non-inferiority margin met with a difference of 1.60% (97.5% CI -3.34 to ∞).

3-Year Overall Survival:

• Laparoscopic surgery: 91.7% (95% CI 89.3 to 93.5).

• Open surgery: 93.7% (95% CI 90.6 to 95.8).

• HR: 1.34 (95% CI 0.82 to 2.19; p = 0.24).

3-Year Locoregional Recurrence:

• Laparoscopic surgery: 3.7% (95% CI 2.5 to 5.3).

• Open surgery: 2.3% (95% CI 1.1 to 4.3).

• HR: 1.64 (95% CI 0.74 to 3.63; p = 0.22).

5-Year Overall Survival:

• Laparoscopic surgery: 84.6% (95% CI 81.5 to 87.1).

• Open surgery: 86.6% (95% CI 82.5 to 89.8).

• HR: 1.16 (95% CI 0.82 to 1.64; p = 0.41).

This multicenter trial confirms that laparoscopic surgery is non-inferior to open surgery for 3-year disease-free survival in patients with low rectal cancer. These findings provide strong evidence that supports laparoscopic surgery as the effective and minimally invasive alternative to open surgery for low rectal cancer.

Reference:

Jiang, W., Xu, J., Cui, M., Qiu, H., Wang, Z., Kang, L., Deng, H., Chen, W., Zhang, Q., Du, X., Yang, C., Guo, Y., Zhong, M., Ye, K., You, J., Xu, D., Li, X., Xiong, Z., Tao, K., … LASRE trial investigators. (2024). Laparoscopy-assisted versus open surgery for low rectal cancer (LASRE): 3-year survival outcomes of a multicentre, randomised, controlled, non-inferiority trial. The Lancet. Gastroenterology & Hepatology. https://doi.org/10.1016/S2468-1253(24)00273-5