The LapPath study: Comparison of pathologic outcomes of laparoscopic versus open rectal cancer surgery—A retrospective analysis from a tertiary cancer center in South India

ABSTRACT Export Background: Total mesorectal excision (TME), which is the mainstay of the surgical management of carcinoma rectum, can either be achieved by open or laparoscopic techniques. Short-term benefits of laparoscopy were confirmed in previous meta-analyses, which found no difference in overall and disease-free survival, but data on pathologic outcomes of laparoscopy versus open surgery are heterogeneous. Objectives: The objective was to compare the pathological outcomes of laparoscopic with open rectal cancer resection. Materials and Methods: The LapPath (laparoscopic–pathological) study was a retrospective observational study conducted on patients with rectal cancers who underwent surgery between November 2017 and April 2020 at the Malabar Cancer Center, a tertiary cancer hospital in Thalassery, Kannur district in Kerala, South India. We divided the cohort based on whether the patients underwent laparoscopic or open surgery and compared various pathological outcomes in the two groups, including the quality of TME, nodal count, distal, and proximal margins. Results: We enrolled 170 patients, 98 (57%) had undergone laparoscopy and 72 (41.9%) had undergone open surgery. TME was complete in 68 (69.3%), near-complete in 30 (31%), and incomplete in 0 patients who underwent laparoscopic resection, versus 52 (72.2%), 20 (27.8%), and 0 patients who underwent open surgery; P, 0.554. The mean proximal margin was 11.1 cm (standard deviation [SD], 4.9) in the laparoscopic compared to 8.9 cm (SD, 6.5) in the open cohort; P, 0.434. The mean distal margin was 4.3 cm (SD, 2) in the laparoscopic group and 8 cm (SD, 6.6) in the open surgical group; P, 0.036. There were no cases in either group in which the proximal or distal margins were involved. The mean nodal count was also similar between the two groups: 10 (SD, 9.4) in the laparoscopic resection cohort and 9 (SD, 7.5) in the open surgery cohort; P, 0.475. Conclusions: Laparoscopic rectal cancer surgery leads to similar pathological outcomes as open surgery. This study contributes to the evidence for oncologic safety of laparoscopic rectal cancer resections in patients with disease staged up to T3.