Aim: The aim of the present study was to analyse the short-term outcomes after open and combination of open and laparoscopic approach to advanced rectal cancer resection. Method: Of 26 patients with a T4 rectal cancer, 11 received initial laparoscopic approach with vascular ligation and splenic flexure mobilization, followed by en bloc resection through a medial suprapubic incision. The incision length was approximately 10–15 cm, depending on size of the tumour. The rest of the patients had an open approach through 2–3 fold longer, traditional laparotomy. Tumours were 3– 10 cm in diameter. Results: From a retrospectively collected database: length of hospital stay, wound infection, postoperative pain and analgesic consumption, volume of blood loss and blood transfusion, and the time until return of bowel movement were decreased in the mini-laparotomy group compared with the traditional laparotomy group. Operation costs, anastomotic leakage, and intestinal obstruction were similar in the two groups. A longer operating time in patients undergoing initial laparoscopy was observed. Conclusion: Combination of initial laparoscopy followed by mini-laparotomy can potentially offer all the benefits of a minimally invasive approach and achieve safe and feasible en bloc resection of advanced rectal cancer.