Objective: To compare the clinical efficacies between laparoscopic and conventional open surgery for rectal cancer. Methods: Literature search for randomized controlled trials (RCTs) comparing laparoscopic surgery to conventional open surgery for rectal cancer over the past 20 years was performed. The studies were screened according to the inclusion criteria, and then Meta-analysis was performed by using Review Manager 5.1 software. Results: Fourteen RCTs involving 2 114 patients were finally selected, with 1 111 cases in laparoscopic surgery group and 1 003 cases in open surgery group. Compared with open surgery group, in laparoscopic surgery group, the intraoperative blood loss, time to postoperative gastrointestinal function recovery and ambulation, length of hospital stay and wound infection were reduced, and all the differences reached statistical significance (all P<0.05). The incidence of operative complications that included ureteral injury, uroschesis, intestinal obstruction, anastomotic fistula, and incisional hernia showed no statistical difference between the two groups (all P>0.05). The number of removed lymph nodes, length of specimen, rate of positive circumferential resection margin, and incidence of local recurrence, tumor implantation of the incision or puncture hole, and distant metastasis, as well as the 3- and 5-year overall survival, and 3- and 5-year disease free survival between the two groups had no statistical difference (all P>0.05). Conclusion: Laparoscopic rectal cancer surgery has the similar efficacy in oncological outcomes as the conventional open surgery, with the advantages of reduced intra-operative blood loss, rapid postoperative recovery and shorter hospital stay. So it may be used as a standard procedure for rectal cancer.