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Table 1. Randomized trials comparing oncological outcomes with laparoscopic and open surgery
No. of patients Follow-up Local recurrence Overall survival Port site
Study
(L/O) (months) (months) (L/O) (%) (months) (L/O) (%) recurrence (%)
Braga et al. [35] 83/85 54 4/5.2 No difference NA
Jayne et al. [28] 253/128 56 9.4/7.6 60/53 (5 years) 2.4
Green et al. [36] 253/128 63 No difference 83/66 months NA
(median overall survival)
Ng et al. [34] 40/40 76 2.8/8.9 86/91 (5 years) 0
Ng et al. [37] 51/48 90 5/11 75/77 (5 years) 0
L: laparoscopy group; O: open surgery group; NA: not available

Laparoscopic TME for cancer is technically feasible, with acceptable complication rates and short-term on-
cological outcomes that are comparable with those of open surgery.

Long-term oncological outcomes
The few randomized trials comparing long-term outcomes after laparoscopic and open TME consistently
reported that laparoscopic and open TME were associated with similar oncological outcomes [28,34-37] . A
summary comparison of oncological outcomes between laparoscopic and open TME in randomized com-
parative trials are presented in Table 1 .
[38]
Ng et al. investigated patients with rectal cancer who underwent laparoscopic (n = 51) or open abdomi-
[37]
noperineal (n = 48) resection in a single-center prospective randomized trial. In this trial with a median
follow-up duration of 90 months, the 5-year survival rates were 75.2% and 76.5% in the laparoscopic sur-
[34]
gery and the open surgery groups, respectively. Another randomized trial in 2014, again by Ng et al. ,
found that the 5-year survival rates were 86% in the laparoscopic surgery group and 91% in the open sur-
gery group during a median follow-up of 76 months. However, the number of patients receiving neoadju-
vant treatment was not stated in neither of the studies; both of which included a relatively small number of
patients. However, the results of both studies supported that the oncological outcomes of laparoscopic and
open TME were comparable.

[9]
Bonjer et al. published the long-term results of the COLOR II trial in 2015. At the end of the 3-year fol-
low-up, the disease-free survival rates of the laparoscopic and open surgery groups were 74.8% and 70.8%,
respectively, and there was no significant difference in overall survival between the laparoscopic and the
open surgery groups (86.7% and 83.6%, respectively). These results indicated that laparoscopic surgery was
a suitable and valid method in rectal cancer that did not invade the surrounding tissues.

In the CLASSIC trial cohort, the 3-year overall survival rate of the laparoscopic surgery group was not
[6]
worse than that of the open surgery group (68.4% and 66.7%, respectively, P = 0.55) . There was also no
statistically significant difference in disease-free survival between the two groups (67.7% and 66.3% in open
[36]
and laparoscopic surgery, respectively). The long-term results reported by Green et al. revealed that the
median overall survival of patients who underwent surgery for rectal carcinoma was 73.6 months and that
there were no significant differences in the median overall survival (82.7 and 65.8 months) or the disease-
free survival (67.1 and 70.6 months, P = 0.925) between the open and laparoscopic surgery groups, respec-
tively. Furthermore, there were no differences in local, wound, or port recurrent rates between the two
groups. The authors concluded that laparoscopic surgery should be preferred for early functional recovery
without adversely affecting long-term survival outcomes.

Evaluation of the 3-year disease-free survival rates of the COREAN trial found no difference between the
open and laparoscopic surgery groups (72.5% vs. 79.2%), and neither the 3-year overall survival nor the lo-
[39]
cal recurrence parameters exceeded the 15% noninferiority limit .