Locally advance rectal cancer was treated in 144 patients of stages II and III with positive nodes only between 2014 and 17. Combined laparoscopic and trans-anal-rectal excision were performed in all patients, 54 (37.5%) had delayed, and 90 (62.5%) had immediate coloanal anastomoses. Both groups received diverting stoma. Seven patients (4.9%) had pre-sacral collection and anastomotic leakage of which 5 (9.3%) had delayed and 2 (2.2%) had immediate anastomosis. Postoperative obstructions occurred in 5 (9.3%) patients of group delayed and 2 (2.2%) of immediate group. Sepsis and peritonitis was observed in delayed group only—2 (3.7%). One subject died in postoperative due to bleeding and pelvic sepsis in immediate group. Positive circumferential margins above and below were not different between the two groups (p = 0.371, 0.631).Overall survival was 86.8% CI 95% = 74.3–93.5 in the delayed group and 75% CI 95% = 64.6–82.8 in the immediate group. Similarly, 5-year survival was 76% CI 95% = 61.6–85.6 and 69.7% CI 95% = 58.5–78.4 for delayed and immediate anastomoses groups respectively. Overall survival was not significantly different between the two groups (related tests p = 0.429). We conclude from a non-randomized comparative study that combined laparoscopic and trans-anal excision of locally advanced rectal cancer when treated with delayed anastomosis has somewhat higher surgical complications than immediate anastomosis group. However, no difference was observed in the long- and short-term survival between these 2 groups.

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