Laparoscopic versus open surgery for sphincter preservation in mid- and low rectal cancer: a large propensity score-matched cohort study

Recent studies have suggested that laparoscopic surgery for rectal cancer yields postoperative complications and long-term survival rates comparable to those of open surgery. Nevertheless, whether sphincter-preserving rates are equivalent between laparoscopic and open approaches remains a topic of debate. This retrospective study included patients with mid- and low-rectal cancer who underwent open or laparoscopic surgery at Fudan University Shanghai Cancer Center (2006–2021). Propensity score matching (PSM) was used to balance baseline characteristics. Sphincter-preserving rates and short- and long-term outcomes were compared. Data from 9405 rectal cancer patients were collected. After propensity score adjustment, 7738 patients (4993 open and 2745 laparoscopic) with mid- and low- rectal cancer were included. The sphincter-preserving rates were 60.7% in the open surgery group and 72.3% in the laparoscopic surgery group, corresponding to an odds ratio (OR) of 1.70 (95% CI 1.53–1.88, P < 0.001) in the PSM cohort. Subgroup analyses showed that higher sphincter-preserving rates were associated with laparoscopic surgery across different tumor positions. In a sensitivity analysis using multivariable logistic regression in the full unmatched cohort, the adjusted OR was 3.11 (95% CI 2.69–3.59) for laparoscopic versus open surgery. Regarding long-term outcomes, the laparoscopic group had 5- year overall and disease-free survival rates of 77.0% and 76.6% respectively, which were comparable to those of 75.2% and 74.5% for the open surgery group ( P = 0.09 and P = 0.20). For mid- and low-rectal cancer, laparoscopic surgery was associated with higher sphincter-preserving rates than open surgery after PSM, with comparable long-term prognoses.