Comparison of three-year oncological results after restorative low anterior resection, non-restorative low anterior resection and abdominoperineal resection for rectal cancer

Jeroen C. Hol, Thijs A. Burghgraef, Marieke L. W. Rutgers, Rogier M. P. H. Crolla, Nanette A. W. van Geloven, Jeroen W. A. Leijtens, Fatih Polat, Apollo Pronk, Anke B. Smits, Jurriaan B. Tuynman, Emiel G. G. Verdaasdonk, Esther C. J. Consten, Roel Hompes, Colin Sietses

Research output: Contribution to journalArticleAcademicpeer-review


Introduction: Oncological outcome might be influenced by the type of resection in total mesorectal excision (TME) for rectal cancer. The aim was to see if non-restorative LAR would have worse oncological outcome. A comparison was made between non-restorative low anterior resection (NRLAR), restorative low anterior resection (RLAR) and abdominoperineal resection (APR). Materials and methods: This retrospective cohort included data from patients undergoing TME for rectal cancer between 2015 and 2017 in eleven Dutch hospitals. A comparison was made for each different type of procedure (APR, NRLAR or RLAR). Primary outcome was 3-year overall survival (OS). Secondary outcomes included 3-year disease-free survival (DFS) and 3-year local recurrence (LR) rate. Results: Of 998 patients 363 underwent APR, 132 NRLAR and 503 RLAR. Three-year OS was worse after NRLAR (78.2%) compared to APR (86.3%) and RLAR (92.2%, p < 0.001). This was confirmed in a multivariable Cox regression analysis (HR 1.85 (1.07, 3.19), p = 0.03). The 3-year DFS was also worse after NRLAR (60.3%), compared to APR (70.5%) and RLAR (80.1%, p < 0.001), HR 2.05 (1.42, 2.97), p < 0.001. The LR rate was 14.6% after NRLAR, 5.2% after APR and 4.8% after RLAR (p = 0.005), HR 3.22 (1.61, 6.47), p < 0.001. Conclusion: NRLAR might be associated with worse 3-year OS, DFS and LR rate compared to RLAR and APR.

Original languageEnglish
Pages (from-to)730-737
Number of pages8
JournalEuropean Journal of Surgical Oncology
Issue number4
Early online date2022
Publication statusPublished - Apr 2023


  • Laparoscopy
  • Low anterior resection
  • Rectal cancer

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