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

Authors

Hongtu Zheng, Yun Xu, Minzhi Lv, Changming Zhou, Tian'an Guo, Charlie Zhilin Zheng, Ye Xu

Published in

BMC cancer. Volume 26. Issue 1. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

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.

PMID:
43015678
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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