Open resection without derivative stoma for rectal cancer: our experience

Background: The introduction of laparoscopic resection (LR) for rectal cancer (RC) is going to change the surgical treatment of this disease but at the moment only a few RC are treated by LR. Open surgery (OS) is more and more considered an old and potentially obsolete procedure. Many questions regarding the real advantage of above-mentioned new technique remain till now unanswered. Objectives: The aim of this study was to compare the short term results of the metanalysis and of the largest case series considering LR with the results we obtained using a prospective protocol including all consecutive RC treated by OS. Methods: All patients treated for RC were considered for a prospective protocol whose inclusion criteria were open elective resection without derivate stoma including neoadjuvant therapy, TME technique, low and ultralow anastomoses. Exclusion criteria were urgent surgery, incomplete stapler rings and positive hydropneumatic test.Morbidity, mortality and necessity of a derivative stoma were the parameters considered for the comparison. Results: Between 1989 and 2011, 323 patients were included in the protocol. We had a 20,6% morbidity rate and 0,65% mortality rate. 22 patients developed an anastomotic fistula (6,8%). Of these 22 patients, only 9 (2,8%) required a derivative stoma. Conclusions: In our experience OS and LR obtained similar results considering morbidity and mortality rate. The necessity of a derivative stoma in OS is lower than in LR, although the real rate of derivative stoma is not completely evaluated for minimally-invasive surgery in the literature.