Laparoscopic versus open surgery for rectal cancer is the same! An article titled “A randomized trial of laparoscopic versus open surgery for rectal cancer” was published in the New England Journal of Medicine (NEJM) on April 2, 2015. The results of the study, an international multicenter randomized clinical trial (Level I RCT), showed that laparoscopic versus open caesarean surgery (commonly known as “open surgery”) is comparable in the treatment of rectal cancer. This finding has surprised and encouraged surgical colleagues worldwide! Let me answer some of the patient’s questions about this trial in a Q&A format. The patient asks: What is this experiment studying? Dr. K. K. answered: The use of laparoscopic resection for rectal cancer has been widely used, however, there is some evidence that laparoscopic surgery and “open surgery” are somewhat limited in the treatment of rectal cancer. Until today, many patients still have many doubts about the curative effect of laparoscopic surgery: Can laparoscopy really do rectal cancer surgery? To address this long-standing question, this international, multi-center study compared the safety and effectiveness of laparoscopic surgery over a three-year period in patients with rectal cancer who underwent laparoscopic surgery versus those who underwent “major surgery,” including recurrence and metastasis to the pelvis or perineum (local metastasis) and survival. effectiveness of laparoscopic surgery. The patient asks: How was this experiment designed? In this international trial involving 30 hospitals, the trial focused on patients with “a single rectal adenocarcinoma within 375 px of the perineum”. The ratio of patients who underwent laparoscopic surgery or open dissection was 2:1 in the study group. The main indicators of interest in the experiment were the following: 1) the number of patients with local recurrence of tumor within 3 years after surgery; 2) the number of patients who recovered; and 3) the number of all patients who survived. ▪ The patient asked: What are the results of this experiment? The results of the study showed that the local tumor recurrence rate in the two groups was 5.0% (difference 0; 90% confidence interval -2.6 to 2.6). In the experimental group, the proportion of patients who recovered and recovered was 74.8%; in the control group, the proportion of patients who recovered and recovered was 70.8% (difference 4.0%; 95% confidence interval -1.9 to 9.9). Patient survival rates were 86.7% and 83.6% in the experimental and control groups, respectively (difference 3.1%; 95% confidence interval -1.6 to 7.8). ▪ Patient asked: What were the final findings of this trial? The final results suggest that there are currently two main options for surgical treatment of patients with rectal cancer: either minimally invasive surgery using laparoscopy or “open surgery” with an open dissection. After the above-mentioned randomized controlled study, our most important questions were answered: there were no significant differences between the two groups in terms of postoperative tumor recurrence, cure of rectal cancer disease, and survival of patients. In other words, when considering surgical procedures for rectal cancer patients in the future, laparoscopic surgery has the same clinical effect as “open surgery” in terms of effectiveness and safety of surgery. This reminds me of the conclusion of some previous studies: compared with “open surgery”, laparoscopic minimally invasive techniques have the advantages of less bleeding, less trauma, early feeding, faster recovery, less pain, and fewer complications for the same rectal cancer surgery. Finally, I would like to say that through this convincing experiment, it is easy to see that laparoscopy has the same safety and effectiveness as “open surgery” for the surgical treatment of rectal cancer, but “open surgery” is not as minimally invasive as laparoscopic surgery. Therefore, I boldly speculate that in the era of minimally invasive surgery in the 21st century, when surgery is more and more humane, minimally invasive surgery represented by laparoscopy may become an important force to replace “open surgery”!