KEY TAKEAWAYS
- The LASRE trial aimed to assess long-term oncologic outcomes of laparoscopic versus open surgery for low rectal cancer, addressing increasing laparoscopic usage.
- The primary endpoint was to determine DFS.
- The study concluded that laparoscopic surgery, led by experienced surgeons, is as effective as open surgery for 3-year DFS.
The rising utilization of laparoscopic surgery for low rectal cancer is attributed to its short-term advantages over open surgery, yet long-term oncologic outcomes remain uncertain.
Pan Chi and the team spearheaded the study that aimed to assess the growing utilization of laparoscopic surgery for low rectal cancer, focusing on its short-term advantages and incomplete long-term oncologic outcomes.
This multicenter, noninferiority trial involved surgeons with ≥100 laparoscopic TME surgeries from 22 high-volume centers. About 1070 patients were scheduled for curative-intent resection of low rectal cancer (lower margin <5.0 cm dentate line). Patients were randomly assigned in a 2:1 ratio to undergo either laparoscopic or open surgery between November 2013 and June 2018.
The primary outcome was a 3-year disease-free survival(DFS), with a 10% noninferiority margin in the modified intent-to-treat population. Secondary outcomes included 3-year OS and locoregional recurrence.
The final analysis was 1039 patients (median age: 57 years, 620 men; 685 laparoscopic, 354 open). Clinical TNM stage was II/III in 659 patients and I in 380. The 3-year DFS rate was 81.4% with laparoscopic versus 79.8% with open surgery (HR, 0.9 [95% CI, 0.7-1.2]; log-rank P = .558). The absolute difference was 1.6%, with a 1-sided 97.5% CI ranging from -3.34% to infinity, which did not surpass the threshold for noninferiority.
The 3-year OS rate was 91.7% with laparoscopic versus 93.7% with open surgery (95% CI, -5.12% to 1.54%, log-rank P = .243). The 3-year locoregional recurrence rate was 3.8% and 2.4%, respectively (95% CI, -1.07% to 3.45%, log-rank P = .209). The results of per-protocol and as-treated analyses were consistent with the main analysis.
The study concluded that laparoscopic surgery, conducted by experienced surgeons, is comparable to open surgery in terms of 3-year DFS for patients with low rectal cancer. These findings endorse laparoscopic surgery as a safe and minimally invasive option for treating low rectal cancer. Research was funded by Fujian Medical University.
Source: https://meetings.asco.org/abstracts-presentations/229434
Clinical Trial: https://clinicaltrials.gov/study/NCT01899547
Pan C, Su X, Xu J, et al. (2024). “Effect of laparoscopy-assisted vs open surgery on 3-year disease-free survival in patients with low rectal cancer: The LASRE randomized clinical trial.” J Clin Oncol 42, 2024 (suppl 3; abstr 8) 10.1200/JCO.2024.42.3_suppl.8
