Current therapeutic strategies for rectal cancer.

Abstract

surgery was introduced by Stearns et al. in 1959 [2]. On the other hand, Heald et al. demonstrated the usefulness of total mesorectal excision (TME) as the surgical procedure for rectal cancer [3]. Therefore, TME plus preoperative radiotherapy became the standard treatment for advanced rectal cancer [4]. However, in order to further improve the outcome of rectal cancer surgery, different modalities have been attempted, including preoperative chemoradiotherapy and postoperative chemoradiotherapy. Recent advances in chemotherapy for colorectal cancer have made it possible to use new chemotherapeutic agents in preoperative chemoradiotherapy including biological agents. Accordingly, a multidisciplinary approach is now considered to be important in the treatment of rectal cancer. Another epoch-making advancement in surgery for rectal cancer is the introduction of minimally invasive surgery. Laparoscopic surgery for colon cancer was reported in 1991 [5]. Today, there is an increasing number of patients undergoing laparoscopic surgery for colorectal cancer. Large-scale trials have shown that laparoscopic surgery is effective for colorectal cancer, especially regarding the short-term outcome. In Japan, more that 60 % of rectal cancer patients undergo laparoscopic surgery according to the National Clinical Database (NCD). However, there are some limitations associated with laparoscopic surgery, such as the limited range of movement of laparoscopic devices which has been noted. To overcome these limitations, robotic surgery has received attention in recent years. In robotic surgery, increased freedom of movement of the forceps becomes available, which may be very useful for a patient with a narrow pelvis. Consequently, more robotic surgery is now being performed for rectal cancer worldwide. However, the true benefits of robotic surgery Introduction