Background: The laparoscopic surgery for rectal cancer, such as open surgery, is associated with many surgical complications, especially if the surgeon does not have sufficient experience in open total mesorectal excision and advanced laparoscopic surgery. This review aiming at comparing the effectiveness and the complications rate of laparoscopic surgery to those of open surgery. Methods: The comprehensive electronic search was conducted in Medline and Embase databases. The search resulted in 102 relevant clinical trials, which were subjected to primary screening and exclusion of ineligible studies. Finally, 32 potentially relevant clinical trials were included in the secondary screening from which nine clinical trials were included in this review. Data were collected from included studies using data extraction forms, then the qualitative synthesis of extracted data was conducted. Results: Small differences between interventions were reported by the included studies. Five-years survival rates tend to be slightly higher in the open surgery, whereas 3-years survival rates were higher in the laparoscopic surgery. It be attributed to the wider safe margin for tumor excision obtained in open surgery. The complications rates were slightly lower in the laparoscopy groups among most of the included studies. Conclusions: This review found comparable outcomes of laparoscopy and open surgery in treatment of rectal cancer with minimal differences in survival and complications rates.