Laparoscopic versus transanal pelvic exenteration for locally advanced rectal cancer: A comparative study of perioperative and oncological outcomes

Abstract Background This study aimed to retrospectively compare the surgical and oncological outcomes of laparoscopic and transanal pelvic exenteration (PE) for locally advanced rectal cancer. Methods Patients who underwent laparoscopic PE (L-PE, 6 patients) or transanal PE (Ta-PE, 17 patients) between April 2016 and September 2023 were retrospectively analyzed. Results Compared to the L-PE group, the Ta-PE group exhibited a shorter intraoperative time (P = 0.042) and higher anal sphincter preservation rate (P = 0.045). There were no significant differences in other perioperative clinical outcomes between the two groups. The median value for follow-up duration was 32 months and there were no differences in the 5-year overall survival (L-PE versus Ta-PE: 69.3% versus 19.7%; P = 0.155), disease-free survival (L-PE versus Ta-PE: 22.2% versus 45.4%; P = 0.494) or local recurrence-free survival (L-PE versus Ta-PE: 60.0% versus 93.8%; P = 0.189) rates. Conclusions Ta-PE is a promising approach for locally advanced rectal cancer in terms of improving perioperative outcomes compared with L-PE.