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The laparoscopic approach to rectal cancer is still a controversial procedure. A comparative cohort study was conducted to assess short-term results of laparoscopic restorative mesorectal excision.From January 1998 to December 2000, laparotomy was performed on all primary rectal cancer undergoing radical excision. From January 2002 to September 2004, all cases about to undergo radical excision were considered for laparoscopy. Patients with fixed tumor or T4, indications for synchronous hepatectomy, emergencies, and medical contraindications were not included. The study was based on the intention-to-treat principle.Short-term outcome was compared between the laparoscopy group (n=104) and the laparotomy group (n=68). Demographic, general and tumor data, and rates of preoperative irradiation were comparable, as were surgical procedures and perioperative management. Hospital mortality (1 and 2.9 percent,P=0.33) and three-month overall morbidity (43.3 and 48.5 percent,P=0.49) were comparable between laparoscopy and laparotomy groups. Surgical complication rates were comparable (39.3 and 35.5 percent,P=0.58), but a significantly lower medical complication rate was observed in laparoscopy patients (8.7 and 20.6 percent,P=0.025), mainly because this group had fewer respiratory complications. Hospital stay was shorter in laparoscopy patients (10 and 14 days,P<0.001). Oncologic quality criteria were comparable, in terms of number of lymph nodes, lateral and distal margins, and delivery of postoperative chemotherapy.The laparoscopic approach to restorative mesorectal excision for cancer does not increase postoperative morbidity or reduce oncologic quality. Our results suggest that the short-term outcome is probably improved with this procedure.