Functional and oncological outcomes after laparoscopic versus open total mesorectal excision for rectal cancer: a propensity score-matched study

Abstract

While minimally invasive surgery and traditional open surgery are generally equivalent in terms of oncological outcomes for rectal cancer, maintaining postoperative quality of life is increasingly important. Low anterior resection syndrome is a distressing complication following sphincter-preserving surgery that severely impacts a patient's normal life. This study aims to systematically compare the short-term clinical efficacies of laparoscopic total mesorectal excision and open radical surgery, using LARS scoring system to objectively evaluate postoperative anal function. A retrospective, single-center analysis was conducted on clinical data from patients who underwent radical resection for mid-low rectal cancer at Nanjing Drum Tower Hospital Group Suqian Hospital from January 2020 to March 2023. Following strict inclusion and exclusion criteria, 361 patients were initially selected. To mitigate baseline imbalances, a 1:2 propensity score matching was utilized, yielding a final matched cohort of 160 patients in the LaTME (laparoscopic total mesorectal excision) group and 80 patients in the OsTME (open total mesorectal excision) group. Both groups demonstrated highly comparable oncological efficacy, achieving negative circumferential resection margins in 97.50% of cases and complete total mesorectal excision in over 96.00% of cases. Additionally, 1-year and 3-year disease-free survival and overall survival profiles showed no statistically significant differences between the two modalities. While systemic postoperative complications were similar between groups, the LaTME cohort experienced a significantly lower rate of postoperative urinary retention (1.90%) compared to the OsTME cohort (8.80%, p  = 0.030). For patients without a diverting ileostomy, the LaTME group had a notably lower incidence of severe LARS at one month postoperatively (23.35%) compared to the OsTME group (35.93%, p  = 0.009). This functional disparity diminished by six months, at which point both groups equalized. Subgroups requiring an ileostomy showed no significant differences in LARS scores following stoma reversal. Laparoscopic total mesorectal excision provides equivalent oncological outcomes to traditional open surgery for mid-low rectal cancer. LaTME offers superior short-term functional benefits by reducing postoperative urinary retention and substantially decreasing the severity of early Low Anterior Resection Syndrome. These minimally invasive advantages support prioritizing LaTME to maximize functional preservation and patient quality of life.