In this study, the major cause for conversion was an inadequate laparoscopic resection leading to an inadequate excision. Preoperative colonoscopic tattooing was a safe and effective method for tumor

localization in laparoscopic colorectal surgery (25). Intraoperative colonoscopy was also a way of definitively localizing a lesion (26). Port site recurrence has been PFI-2 in vivo reported after laparoscopic resection of colorectal cancer (0-1.4%) (24,27). In the present Inhibitors,research,lifescience,medical study, there was no port site recurrence. More importantly, there was no difference in overall and disease-free survival between minilaparotomy and laparoscopic group, and local and distant recurrence rates were similar in both groups. Similar results that supported the equivalence of oncologic outcomes have been reported in several single-institution comparative or randomized controlled studies (16,17,28). This study indicates that the minilaparotomy approach is oncologically feasible. In this study, splenic flexure mobilization was conducted when necessary in the laparoscopic approach, Inhibitors,research,lifescience,medical but could not be performed in the minilaparotomy approach because of small incision. Some surgeons, especially those in Western countries, have suggested that wide splenic flexure mobilization was crucial to obtain adequate resection with tension-free anastomosis in rectal cancer

surgery (29). However, Inhibitors,research,lifescience,medical we found that most patients need not splenic flexure mobilization to complete the anastomosis in the minilaparotomy approach, unless some Inhibitors,research,lifescience,medical patients with very short sigmoid colon and large quantities of mesentery fat. Some investigators from Asian countries have shown that Laparoscopic and open procedures without routine splenic Inhibitors,research,lifescience,medical flexure mobilization in the treatment of rectal cancer was feasible and did not seem to increase postoperative morbidity or oncologic risk (30,31). The patients in minilaparotomy group were not overweight, because obesity was

the risk factor preventing the success of the minilaparotomy approach in the resection of colorectal Thiamine-diphosphate kinase cancer (32), and almost all surgeons seem to agree that obesity reduced the technical feasibility of the minimally invasive laparoscopic and minilaparotomy approaches (3,10,11). Since the incidence of overweight or morbidly obese patients in Asia is probably lower than in Western countries (12,33), we feel that minilaparotomy is a suitable technique for many Asian patients with rectal cancer. In conclusion, minilaparotomy approach is comparable to the laparoscopic approach in terms of postoperative complications and oncological outcomes, demonstrating the feasibility and the efficacy of the minilaparotomy approach. Laparoscopic approach has an advantage over minilaparotomy approach in allowing earlier recovery. However, this is at the expense of a longer operating time and higher direct costs.