Table 1 Patient demographics Operative details As shown in Table 2, operative time was longer in the laparoscopic group, but the time to resumption of normal diet was significantly shorter in the laparoscopic group as compared to the minilaparotomy group (median 4 vs. 5 days, P=0.024). Both groups were comparable for postoperative pain score. There were no differences between the two groups for the time to Inhibitors,research,lifescience,medical first bowel movement (median 3 vs. 4 days, P=0.056).Length of hospital stay was lower in the laparoscopic group (median 7 vs. 8 days, P=0.043). Table 2 Perioperative outcomes The rate of conversion was 8.8% (5/57). The reasons for conversion were bleeding

(n=1), pelvic adhesion (n=1) and difficulty in obtaining distal length to accomplish the anastomosis (n=3).The costs

in the laparoscopic group were significantly Inhibitors,research,lifescience,medical higher than the minilaparotomy group (mean USD 5,532 vs. USD 3,913, P<0.001) (Table 2). Mortality and morbidity There were no postoperative mortality in the laparoscopic group, and two deaths occurred in the minilaparotomy group due to pulmonary embolism and myocardial infarction respectively. Twenty one patients had complications in the laparoscopic group (36.8%) and 29 patients Inhibitors,research,lifescience,medical had complications in the minilaparotomy group (44.6%). The total number of adverse events were 29 (50.9%) and 42 (64.6%), respectively (Table 3).In the minilaparotomy group, reoperation was required in two patients due to anastomotic Inhibitors,research,lifescience,medical leak (n=1) and incisional hernia (n=1). Table 3 Comparison of postoperative complications between two groups Oncological outcome The pathological tumor stage was similar in both groups (Table 4). There was no YM155 significant difference in the tumor-free Inhibitors,research,lifescience,medical distal margin between the groups, but the positive circumferential margin rate was slightly higher in the laparoscopic group although the difference was not

statistically significant (Table 4). Table 4 Oncological results The mean follow up was 56.6 months (range, 10-84 months). There was no difference in local recurrence (5.3% vs. 1.5%, P=0.520) and distant recurrence (8.8% vs. 15.4%, P=0.267) between the two groups. Overall 5-year survival was 87.1% in the laparoscopic group and 82.5% in the minilaparotomy group (Figure 4; P=0.425). Disease-free survival in both groups is shown in Figure 5. Figure 4 Overall survival rate of patients with laparoscopic and minilaparotomy 17-DMAG (Alvespimycin) HCl rectal cancer surgery. Figure 5 Disease-free survival rate of patients with laparoscopic and minilaparotomy rectal cancer surgery. Discussion This study comparing laparoscopic with open rectal cancer resection showed that the minilaparotomy approach was similarly safe and oncologically equivalent to laparoscopic approach, and performed with a shorter operative time and lower in-hospital costs than laparoscopic approach.