Postoperative complications were classified according to the Clavien-Dindo classification of surgical complications and the grades of complication were recorded. Bladder evacuation disorder was defined as urinary incontinence or incomplete evacuation necessitating catheterization >4 weeks

after surgery. Postoperative sexual dysfunction was defined as new onset erectile and/or ejaculatory dysfunction in male patients and as impairment of vaginal lubrication in female patients. The data was collected using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire at 24 months after initial surgery. The costs Inhibitors,research,lifescience,medical of the two operations were estimated by summing up the market Inhibitors,research,lifescience,medical value of theater time, disposable instruments used, and hospitalization service charge. After discharge, follow-up was arranged regularly for buy Lapatinib clinical examination and carcinoem-bryonic antigen (CEA) test at 3-month intervals in the first two years and at 6-month intervals thereafter. The ultrasonography or imaging was not

routinely performed. This was only indicated when there was a clinical suspicion of disease recurrence or when CEA level increased over time. Local recurrence of cancer was defined as the radiologically evidence of tumor recurrence Inhibitors,research,lifescience,medical and/or histologically proven tumor within the operation field. Local recurrence in combination with distant recurrence was also considered as a local recurrence Inhibitors,research,lifescience,medical event. Distant metastases were defined as any recurrence occurring outside the pelvis. Pathological evaluation The rectal specimen was examined in the operation room by the surgeon to assess the distal resection margin and was then sent fresh to the histopathological department, where it was pinned on a cork board. The surface of the mesorectum was inked before slicing to assess the circumferential resection margin. Inhibitors,research,lifescience,medical Microscopic assessment included tumour infiltration through the bowel wall (T), the presence of positive lymph nodes (N), and analysis of the distal and circumferential resection margins. The circumferential resection margin was considered to be positive if it was <1 mm. Statistical analysis

Data were analyzed using the SPSS 16.0 software (SPSS, Chicago, IL, USA). The chi-square test was used for categorical variables. The Student t test or Mann-whitney U test were used for parametric and nonparametric continuous variables. Survival was calculated using the Kaplan-Meier method, and comparison between survival curves was performed using and the log-rank test. Statistical significance was defined as P<0.05. Results Characteristics of patients Between January 2005 and January 2008, 197 patients with rectal cancer were deemed eligible for participation in the study. Seventy five patients were excluded. The remaining 122 patients were allocated to rectal resection via a minilaparotomy (n=65) or via the laparoscopic approach (n=57). The consort flow chart is presented in Figure 3. Figure 3 The consort diagram of patient flow.