”The study involved more than 1,000 patients, and it is important for patients with rectal cancer (preoperative staged cancer without adjacent organ invasion) and the treating physicians to ensure that the laparoscopic approach is safe and feasible before surgery and can provide some short-term benefits, such as less postoperative pain and faster recovery,” said lead author Professor H. Jaap Bonjer (Professor of Surgery, VU University Medical Center) said. “Therefore, laparoscopic surgery should be performed in this type of rectal cancer patients.” Laparoscopic surgery is currently widely used in the treatment of colorectal cancer. According to background information in the article, laparoscopic surgery offers good short-term benefits, such as less pain, less intraoperative bleeding and faster postoperative recovery, compared with traditional open surgery. Although long-term randomized controlled trials suggest that the prognosis of the laparoscopic approach for colon cancer is largely similar to that of the traditional open approach. However, comparisons between the two in rectal cancer lack valid comparisons due to the lack of high-quality experimental evidence for clinicians, Dr. Bonjer explained. Another approximately one-third of colorectal cancers develop in the rectum. The study was conducted simultaneously in 30 hospitals in eight countries. From February 2004 to March 2010, researchers received patients with rectal cancer and randomly assigned them to undergo laparoscopic or open surgery. Patients in the study had a single adenocarcinoma of the rectum that was within 15 cm of the anal verge and had no adjacent organ invasion or distant metastases. Patients with rectal cancer that was difficult to treat laparoscopically (clinical stage T3 or T4, CT and MRI tumors less than 2 mm from the pelvic wall) were excluded. Participating patients underwent further neoadjuvant chemotherapy according to local hospital criteria, and there was no statistical difference between the two groups in terms of neoadjuvant chemotherapy. Follow-up included pelvic, liver, and chest imaging at 3 years postoperatively and clinical examination at 5 years postoperatively. Researchers evaluated the quality of laparoscopic surgery by documenting specific step-by-step procedures at each medical center. The analysis was performed on 1044 patients who participated in the study (699 laparoscopic procedures and 345 open procedures). The results showed essentially similar local recurrence rates at 3 years (both 5%, 9 percentage point difference [95% confidence interval -2.6 to 2.6 percentage points]). Both groups had similar disease-free survival (74.8% in the laparoscopic group vs. 70.8% in the open group, 4 percentage points difference [95% confidence interval -1.9 to 9.9 percentage points]) and overall survival (86.7% in the laparoscopic group vs. 83.6% in the open group, 3.1 percentage points difference [95% confidence interval -1.6 to 7.8 percentage points]). Patients with low-grade rectal cancer in the lower 1/3 of the rectum had a lower local recurrence rate after laparoscopic surgery compared with conventional open surgery. One possible reason for this is that laparoscopic surgery has a better surgical view in the narrow pelvis compared with the traditional open surgical approach, the authors write. ”All indications are that laparoscopic surgery has better disease-free survival in patients with local lymph node-positive rectal cancer and that laparoscopic treatment has a lower local recurrence rate for low-grade rectal cancer.” Professor Bonjer added. The laparoscopic group had a longer operative time (53 minutes longer), a shorter hospital stay (1 day shorter), and earlier recovery of gastrointestinal function (1 day earlier) compared to the conventional open group. The investigators did not perform uniform analysis of the resected specimens for visual and microscopic evaluation, which may be an aspect of the limitations of this study. In addition, the use of different imaging techniques for preoperative evaluation of staged tumors at each hospital in this study also had an impact on the study. Finally, the researchers excluded the hand-assisted laparoscopic approach (in which the surgeon passes an assisted hand deep into the abdominal cavity through an abdominal assisted opening to assist the laparoscopic operation). ”Laparoscopic surgery offers short-term and even long-term surgical advantages, but requires considerable expertise to perform the procedure,” emphasizes Prof. Bonjer.