Abstract
In colon cancer surgery, laparoscopic resection is a safer and more feasible method than open resection; however, despite its increasing popularity in recent years, laparoscopic approaches for the treatment of rectal cancer have not become a standard therapy option, due to the technical difficulties in gaining access to the deep and narrow pelvis and the steep learning curve. Multiple randomized trials found that short-term oncological outcomes and perioperative mortality and morbidity were comparable between laparoscopic and open rectal surgery, whereas comparative data between the two approaches. Comparative data between the two approaches on long-term oncological outcomes remain limited. In this review, we summarize the current status of laparoscopic surgery in rectal cancer in the light of recent studies.
Highlights
Colorectal cancer is one of the most commonly diagnosed cancers worldwide and is responsible for approximately 750,000 cancer-related deaths annually[1]
The most significant improvement in rectal surgery was the widespread implementation of the total mesorectal excision (TME) technique, first described by Heald et al.[2] in 1982, which led to a reduction in locoregional recurrence rates from 25% in the 1980s to under 4% today[1]
There is no difference in the completeness of TME between the laparoscopic and open surgery groups (82% vs. 89%), circumferential surgical margin (CRM) positivity was observed in 7% and 3% of the laparoscopy and open surgery group patients, respectively (P = 0.06), and the rate of conversion to open surgery was 9%
Summary
Colorectal cancer is one of the most commonly diagnosed cancers worldwide and is responsible for approximately 750,000 cancer-related deaths annually[1]. The most significant improvement in rectal surgery was the widespread implementation of the total mesorectal excision (TME) technique, first described by Heald et al.[2] in 1982, which led to a reduction in locoregional recurrence rates from 25% in the 1980s to under 4% today[1]. Laparoscopic surgery has numerous benefits, such as shorter length of hospitalization, reduced postoperative pain, and improved recovery[4,5,6]. Concerns regarding laparoscopic rectal surgery are port-site and abdominal wall metastases and local oncological clearance[11,12,13,14,15]. Laparoscopic rectal surgery has a challenging learning curve because of the deep and narrow pelvis and its assist-dependent procedure[16]
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