Abstract
Minimal invasive surgery (MIS) is an accepted modality of treatment for rectal cancer. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center. However, safety and feasibility of laparoscopic surgery and robotic surgery in beyond total mesorectal excision (b-TME) and extended TME (e-TME) are not well established. This review summarizes the current evidence for MIS approach for b-TME/extended resections in rectal cancer. A systematic search was carried out in PubMed. Studies available in English related to MIS approach in b-TME/e-TME in rectal cancers were identified and evaluated. This review concludes MIS is feasible with good perioperative outcomes in b-TME/e-TME in carefully selected patients. Laparoscopic surgery has considerable learning curve and should be performed by experienced surgical teams. Robotic surgery is feasible and beneficial in complex resection in pelvis. However, evidence for long-term oncological outcomes of MIS in b-TME/e-TME is low and needs to be studied further by randomized controlled trial once enough numbers are possible in institutes with high volume rate.
Highlights
Total mesorectal excision (TME) is a standard of care for primary rectal cancer located within mesorectal fascia
The indications for Minimal invasive surgery (MIS) have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center, which suggested laparoscopic surgery is feasible with good perioperative outcomes[23,24,25]
This review summarizes current evidence for MIS approach for b-TME/extended resections in rectal cancer
Summary
Total mesorectal excision (TME) is a standard of care for primary rectal cancer located within mesorectal fascia. Laparoscopic resection improves perioperative outcomes, including decrease in intraoperative blood loss, postoperative pain, ileus, and duration of hospital stay Randomized trials such as the CLASICC (Conventional vs LaparoscopicAssisted Surgery in Colorectal) trial, COREAN (Comparison of Open vs Laparoscopic Surgery for Mid or Low Rectal Cancer after Neoadjuvant Chemoradiotherapy) trial, and COLOR II (Colorectal Cancer Laparoscopic or Open Resection II) trials have confirmed the feasibility and oncological safety of laparoscopic surgery in TME[11,12,13]. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center, which suggested laparoscopic surgery is feasible with good perioperative outcomes[23,24,25]. This review summarizes current evidence for MIS approach for b-TME/extended resections in rectal cancer
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