Our results also showed that the laparoscopic approach for rectal cancer was associated with an earlier resumption of normal diet and shorter hospital stay, and the time to first bowel movement was shorter in laparoscopic group, but not significant. Contrary to what has been reported previously, the present

study failed to demonstrate lower pain scores for the laparoscopic group (15,16). An explanation could be the use of Inhibitors,research,lifescience,medical five ports and an about 5 cm abdominal incision for specimen retrieval in the laparoscopic group that might produce more wound pain. The more analgesic consumption might also limit postoperative recovery. The postoperative complication rate was less in the laparoscopic group,

but the difference did not reach significance. Anastomotic leak rate was 1.8% in Inhibitors,research,lifescience,medical the laparoscopic group and 3.1% in minilaparotomy group. This leak rate was similar to the results in other studies in the NLG919 molecular weight literature (1-13.5%) (4,16-19). Most of the long-term complications such as anastomotic stenosis, incisional hernia and urogenital dysfunctions were minor and the reoperation rate was low in both arms. This study therefore suggests that the minilaparotomy approach is as safe as the laparoscopic approach and does not lead to higher morbidity. In the present study, the number of lymph nodes harvested was not different between the two groups. The distance between the tumor and Inhibitors,research,lifescience,medical distal resection margin was slightly Inhibitors,research,lifescience,medical less in the laparoscopic group and the rate of involved circumferential margin was higher, although these differences were not statistically significant. This finding is similar to the findings in the CLASICC-trial where the circumferential margin involvement rate was 12% in the laparoscopic group and 6% in the open group (P>0.05) (4,17). The CLASICC trial suggested that laparoscopic Inhibitors,research,lifescience,medical LAR could be associated with a slightly increased risk of local recurrence (4). However, recent studies suggested laparoscopic results showed equal distal margin length and the rate of margin positivity when compared to open surgery (20). A possible explanation

may be DNA ligase that we did not have a longer learning curve and enough experience, and could not obtain enough distal length and locate the tumor to accomplish the anastomosis in many very low rectal cancer patients. Furthermore, in laparoscopic surgery, we used linear stapler which cannot bend at the distal shaft. It was very difficult for us to get longer distal margin in low rectal patients with narrow pelvis. The third reason may be that the tumors were slightly more distal and lower in the laparoscopic group compared with the minilaparotomy group. Conversion to an open operation is an important indicator for laparoscopic success. The conversion rate was 8.8%, which was similar to the rates reported in the literature (6-15.5%) (16,21-23).