Laparoscopic or open surgery in low rectal cancer?

Laparoscopic-assisted rectal resection was non-inferior to open surgery regarding disease-free survival (DFS) in patients with low rectal cancer, results of the randomised-controlled LASRE trial showed. Other outcomes, such as sphincter preservation and duration of hospital stay, favoured the laparoscopic-assisted surgery arm.

The multicentre, non-inferiority, randomised-controlled LASRE trial (NCT01899547) compared laparoscopic-assisted rectal resection with conventional open surgery in 1,070 patients with low rectal cancer who did not have evidence of pelvic lateral lymph nodes or distant metastasis. Randomisation occurred in a 2:1 fashion, with the majority of participants being randomised to the laparoscopic-assisted surgery arm. The primary endpoint was 3-year DFS. Prof. Pan Chi (Fujian Medical University, China) presented the findings [1].

There was no difference between the 2 study arms regarding 3-year DFS (81% vs 79%; HR 0.92; 95% CI 0.69–1.23; log-rank P=0.56). This result was consistent across clinical stage I and clinical stage II/III subgroups of patients. Similarly, there was no difference in 3-year overall survival between the study arms (HR 1.34; 95% CI 0.82–2.19; log-rank P=0.24). “However, laparoscopic-assisted surgery was favoured over open surgery regarding sphincter preservation (71.7% vs 65.0%; P=0.03) and duration of hospitalisation (median 8.0 days vs 9.0 days; P=0.008),” noted Prof. Chi.

In conclusion, the results of the LASRE trial support the use of laparoscopic-assisted surgery in patients with low rectal cancer.

1. Chi P, et al. Effect of laparoscopic-assisted vs open surgery on 3-year disease-free survival in low rectal cancer: the LASRE randomized clinical trial. Abstract 8, ASCO Gastrointestinal Cancers Symposium 2024, 18–20 January 2024, San Francisco, CA, USA.

 

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Posted on 13 February, 202428 March, 2024