Comparative Outcomes of Laparoscopic Versus Open Surgery for Low Rectal Cancer: A Matched Case–Control Study

Background: Low rectal cancer presents unique surgical challenges due to the confined pelvic anatomy and the need to balance oncologic clearance with sphincter and nerve preservation. Laparoscopic surgery has emerged as a minimally invasive alternative to open surgery, but concerns remain regarding oncological adequacy in low rectal tumors. Objective: To compare perioperative, oncological, and functional outcomes between laparoscopic and open surgery for low rectal cancer. Methods: This retrospective matched case–control study included 60 patients with histologically confirmed low rectal adenocarcinoma treated at Dr. Rajendra Gode Medical College. Thirty patients underwent laparoscopic low anterior resection (L-LAR) or laparoscopic abdominoperineal resection (L-APR), and 30 underwent open surgery (O-LAR or O-APR), matched for age, tumor stage, and comorbidities. Perioperative outcomes, oncological quality (R0 resection, circumferential resection margin [CRM], lymph node yield), and functional outcome using the Low Anterior Resection Syndrome (LARS) score at 6 months were compared. Results: Laparoscopic surgery had a longer operative time (198 ± 35 vs 164 ± 28 min; p