In the July issue of The Lancet Oncology, Sung.Bum Kang and colleagues1 present the short.term outcomes of open resection versus laparoscopic resection in T3 rectal cancers that are pretreated with chemoradiation. This multicentre, randomised trial showed excellent technical results for the laparoscopic surgery group, including a low incidence of complications (21.2%), incomplete total mesorectal excision (4.7%), conversion to open surgery (1.2%), and a high yield of lymph nodes (median 17). Furthermore, the rate of circumferential resection margin (CRM) positivity was lower in the laparoscopic group than in the open surgery group (2.9% vs 4.1%), although this finding was not significant. The presence of microscopic tumour cells within 1 mm of the CRM is the independent factor that is most strongly associated with local recurrence and distant metastases in rectal cancer. The investigators conclude that laparoscopic surgery after preoperative radiochemotherapy did not jeopardise CRM positivity compared with open surgery.
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