Pathologic Outcomes of Laparoscopic vs Open Mesorectal Excision for Rectal Cancer

To the Editor In their recent article in JAMA Surgery, Martínez-Pérez et al¹ question the oncological safety of laparoscopic surgery in patients with rectal cancer. Their conclusion differs from the findings of a systematic review by Arezzo et al,² who concluded that laparoscopic resection of rectal cancer was oncologically safe. Inclusion of the early results of the ACOSOG and ALaCaRT trials in the meta-analysis by Martínez-Pérez et al¹ led to their recommendation to await long-term outcome studies before determining the definitive role of laparoscopic surgery in patients with rectal cancer. Although more than 400 patients were accrued in both trials, the 95% CIs of the ACOSOG and ALaCaRT trials ranged from −11.0 and −12.4, respectively, to infinity, qualifying these trials as level 2b according to the Oxford Levels of Evidence.³