Oncological Outcomes and Quality of Life After Rectal Cancer Surgery.

Roberto Peltrini,Antonio Tufano,Emanuele Caruso,Gianluca Pagano,Gaetano Luglio,Mariano Cesare Giglio,Giovanni Domenico De Palma,Viviana Sollazzo,Gianluca Cassese,Michele Sacco,Alfonso Amendola,Luigi Bucci

doi:10.1515/med-2019-0075

Abstract

Surgery for rectal cancer has been completely revolutionized thanks to the adoption of new technologies and up-to-date surgical procedures that have been applied to the traditional milestone represented by Total Mesorectal Excision (TME).The multimodal and multidisciplinary approach, with new technologies increased the patients’ life expectancies; nevertheless, they have placed the surgeon in front of newer issues, represented by both oncological outcomes and the patients’ need of a less destructive surgery and improved quality of life.In this review we will go through laparoscopic, robotic and transanal TME surgery, to show how the correct choice of the most appropriate technique, together with a deep knowledge of oncological principles and pelvic anatomy, is crucial to pursue an optimal cancer treatment. Novel technologies might also help to decrease the patients’ fear of surgery and address important issues such as cosmesis and improved preservation of postoperative functionality.

Highlights

The multimodal and multidisciplinary approach, with new technologies increased the patients’ life expectancies; they have placed the surgeon in front of newer issues, represented by both oncological outcomes and the patients’ need of a less destructive surgery and improved quality of life.In this review we will go through laparoscopic, robotic and transanal Total Mesorectal Excision (TME) surgery, to show how the correct choice of the most appropriate technique, together with a deep knowledge of oncological principles and pelvic anatomy, is crucial to pursue an optimal cancer treatment
They recognized that laparoscopic surgery in patients with rectal cancer is safe and effective with both local recurrence and overall and disease-free survival rates similar to those achieved through the open surgery approach
In this regard it is worth pointing out an important phase II open label prospective randomized controlled trial by Kim et al that is currently underway [35], in order to compare the quality of TME specimen, circumferential resection margins (CRM), distal resection margin (DRM), the number of harvested lymph nodes, morbidity, bowel function recovery, and quality of life

Summary

Introduction

The multimodal and multidisciplinary approach, with new technologies increased the patients’ life expectancies; they have placed the surgeon in front of newer issues, represented by both oncological outcomes and the patients’ need of a less destructive surgery and improved quality of life. Technology has a strong impact on the management of colorectal malignancy, starting from the availability of new diagnostic tools that allow an early diagnosis. In this regard, a crucial role is played by new endoscopic devices [6]. Laparoscopy, Robotic, Transanal Total Mesorectal Excision (Ta-TME) and Transanal Minimally Invasive Surgery (TAMIS), are current approaches that perform minimally invasive procedures for rectal cancer surgery They have been proposed mainly to overcome technical challenges in difficult pelvic dissections, but no evidence exist to date demonstrating that such techniques provide benefits in functional and oncological results, other than improving cosmesis and offering better recovery outcomes. We will discuss the current advances of rectal cancer surgery, trying to emphasise the rationale of new techniques and surgical approaches, on the basis of anatomical and histological considerations, as well as patients’ quality of life related issues

Laparoscopic surgery for rectal cancer

Oncological outcomes after laparoscopic rectal cancer surgery

Robotic surgery for rectal cancer

Quality of life: what’s the role of novel technologies?

Findings

Conclusions