# Early Complication Differences Between Laparoscopic and Open Abdominoperineal Resection

## TL;DR

Laparoscopic surgery for rectal cancer reduces early complications and hospital stays compared to open surgery, despite longer operation times.

## Contribution

A prospective comparative study at a single center evaluating early postoperative outcomes of laparoscopic versus open abdominoperineal resection for low rectal cancer.

## Key findings

- LAPR had fewer overall complications (20% vs. 51.1%) compared to OAPR.
- LAPR resulted in lower surgical site infections (8.9% vs. 24.4%) and pulmonary complications (2.2% vs. 13.3%).
- LAPR patients had reduced blood loss and shorter hospital stays despite longer operative times.

## Abstract

Background

Abdominoperineal resection (APR) is a common surgical approach for low rectal cancer (RC). With advancements in minimally invasive techniques, laparoscopic APR (LAPR) has gained popularity. However, comparative data on early postoperative complications between laparoscopic and open APR (OAPR) remain limited at Jinnah Postgraduate Medical Centre (JPMC), Karachi.

Objective

The primary endpoint of the study was to evaluate any 30-day postoperative complications. Secondary endpoints included surgical site infection (SSI), pulmonary complications, intraoperative blood loss, operative time, and length of hospital stay. The study aimed to compare these outcomes between laparoscopic and OAPR in patients with low RC. It was hypothesized that patients undergoing LAPR would have fewer early postoperative complications than those undergoing OAPR.

Methodology

This prospective, comparative observational study was conducted at JPMC, Karachi, from January 2024 to January 2025. A total of 90 patients diagnosed with low rectal adenocarcinoma were enrolled and divided equally into two groups: LAPR (Group A) and OAPR (Group B). Standardized surgical techniques were employed in both groups. Patients were monitored for 30 days postoperatively for complications such as SSIs, pulmonary issues, ileus, and reoperations. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2018; IBM Corp., Armonk, NY, USA), with significance set at p < 0.05.

Results

The laparoscopic group had a longer mean operative time than the open group (195.2 ± 23.4 vs. 158.7 ± 20.1 minutes, p < 0.001) but showed reduced intraoperative blood loss (120.5 ± 40.8 vs. 285.3 ± 60.2 mL, p < 0.001), shorter hospital stay (6.2 ± 1.4 vs. 9.3 ± 2.1 days, p < 0.001), and fewer overall complications (20% vs. 51.1%, relative risk 0.39, p = 0.002). SSIs (8.9% vs. 24.4%, RR 0.37, p = 0.047) and pulmonary complications (2.2% vs. 13.3%, RR 0.17, p = 0.048) were also significantly lower in the laparoscopic group.

Conclusions

In this single-center prospective cohort, LAPR was associated with fewer early postoperative complications, lower blood loss, and shorter hospital stays than OAPR, despite longer operative time. These findings suggest that LAPR may be a reasonable option in appropriately selected patients, but confirmation in multicenter randomized studies with long-term oncologic outcomes is warranted.