• laparoscopic surgery
• meta‐analysis
• non‐inferiority
• open surgery
• rectal cancer

• Humans
• Laparoscopy/methods
• Laparoscopy/adverse effects
• Margins of Excision
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Proctectomy/methods
• Proctectomy/adverse effects
• Randomized Controlled Trials as Topic
• Rectal Neoplasms/surgery
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Treatment Outcome

• Beijing Shijitan Hospital Professionals Training Program (NO.2023LJRCDL)

• High ligation
• low ligation
• lymph node dissection

• Anastomotic Leak/epidemiology
• Case-Control Studies
• Colectomy/methods
• Colectomy/statistics & numerical data
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Data Interpretation, Statistical
• Female
• Humans
• Lymph Nodes/pathology
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures/methods
• Minimally Invasive Surgical Procedures/statistics & numerical data
• Neoplasm Staging/methods
• Perioperative Period/mortality
• Postoperative Complications/epidemiology
• Retrospective Studies
• Safety
• Treatment Outcome

• clinical efficacy
• da Vinci robot
• intersphincteric resection
• laparoscope
• low rectal cancer

This study investigated the results of transanal total mesorectal excision (TaTME) combined with laparoscopy for locally advanced mid–low rectal cancer.

Patients with mid–low locally advanced rectal cancer (T3 category or above and/or N+) who underwent rectal resection with TaTME technique were enrolled prospectively. Patients who had distant metastasis, multiple malignancies, intestinal obstruction or perforation, or a clinical complete response to chemoradiotherapy were excluded. Postoperative results, including morbidity, circumferential resection margin (CRM) assessment, short‐term survival and functional outcomes, were analysed.

Thirty‐eight patients, with 25 mid and 13 low rectal tumours, who had elective resection by TaTME from March 2015 to September 2018 were included. There were 25 men and 13 women. Mean(s.d.) age was 58·2(16·4) years and mean(s.d.) BMI was 24·2(2·5) kg/m². Tumours were 3–9 cm from the anal verge. Mean(s.d.) duration of surgery was 210(42) min. All patients had hand‐sewn anastomoses and protective ileostomies. There were no conversions, abdominal perineal resections or postoperative deaths. Four patients had a complication, including three presacral abscesses, all managed by transanastomotic drainage. At 3 months after ileostomy closure, all patients had perfect continence. Apart from a greater tumour diameter in patients with low rectal cancers (6·0 cm versus 4·6 cm in those with mid rectal tumours; P = 0·035), clinical features were similar in the two groups. CRM positivity was greater for low than for mid rectal tumours (3 of 13 versus 0 of 25 respectively; P = 0·034), and more patients with a low tumour had TME grade 2 (4 of 13 versus 1 of 25; P = 0·038). There was no difference in oncological outcomes at 17 months.

Although this study cohort was small, special attention should be paid to bulky low rectal tumours to reduce the rate of CRM positivity.

• Adult
• Aged
• Female
• Humans
• Laparoscopy/methods
• Male
• Margins of Excision
• Middle Aged
• Prospective Studies
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectum/surgery
• Transanal Endoscopic Surgery/methods
• Vietnam

• CRM
• Conversion
• Laparoscopic TME
• MRI
• Minimal Invasive Surgery
• Rectal cancer
• Transanal TME

Laparoscopic intracorporeal colorectal anastomosis with double stapling technique is difficult because of unsuitable cutting angle in narrow pelvic cavity. For reasons of tilted and long linear staple line of rectal stump, circular anastomotic plane can make multiple intersections. The present study was designed to assess whether multiple intersections after double stapling technique is the risk factor of anastomotic complication in laparoscopic colorectal surgery.

In total, 128 consecutive left colon and rectal cancer patients who underwent laparoscopic rectal resection with double stapling technique were enrolled in this study. In all cases, operator tried to reduce intersections by inversion and invagination techniques. They were subdivided into 3 groups: 58 patients with no intersection of staple lines (group A), 62 patients with 1 point of intersection (group B) and 8 patients with 2 points of intersection (group C). Intraoperative air leakage, incomplete cut ring, postoperative bleeding, anastomotic stenosis, and leakage were compared between the 3 groups.

Clinical anastomotic leakage was identified in 1 (group C) of 128 patients (0.7%). Overall anastomotic leakage rate was 0% (0/58) in group A, 0% (0/62) in group B, and 12.5% (1/8) in group C (P=0.001). In univariate analysis, intersections of staple lines were associated with anastomotic complications. There were no statistically significant differences between the 3 groups in multivariate analysis.

The number of intersections of staple lines is associated with anastomotic leakage, and the inversion technique is a useful method for avoiding anastomotic leakage. Using an appropriate technique by skilled operator, double stapling technique for laparoscopic anterior resection is safe and feasible.

Even with the use of nerve-sparing techniques, there is a risk of bladder and sexual dysfunction after total mesorectal excision (TME). Laparoscopic TME is believed to improve this autonomic nerve dysfunction, but this is not demonstrated conclusively in the literature. In Indian patients generally, the stage at which the patients present is late and presumably the risk of autonomic nerve injury is more; however, there is no published data in this respect.

This prospective study in male patients who underwent laparoscopic TME evaluated the bladder and sexual dysfunction using objective standardised scores, measuring residual urine and post-voided volume. The International Prostatic Symptom Score (IPSS) and International Index of Erectile Function score were used respectively to assess the bladder and sexual dysfunction preoperatively at 1, 3, 6 months and at 1 year.

Mean age of the study group was 58 years. After laparoscopic TME in male patients, the moderate to severe bladder dysfunction (IPSS <8) is observed in 20.4% of patients at 3 months, and at mean follow-up of 9.2 months, it was seen only in 2.9%. There is more bladder and sexual dysfunction in low rectal tumours compared to mid-rectal tumours. At 3 months, 75% had sexual dysfunction, 55% at median follow-up of the group at 9.2 months.

After laparoscopic TME, bladder dysfunction is seen in one-fifth of the patients, which recovers in the next 6 months to 1 year. Sexual dysfunction is observed in 75% of patients immediately after TME which improves to 55% over 9.2 months.

• Functional outcome
• laparoscopy
• rectal cancer
• sexual dysfunction
• total mesorectal excision
• urinary dysfunction

• Intersphincteric resection
• Laparoscopic surgery
• Rectal carcinoma

• Chemoradiotherapy
• Complete clinical response
• Rectal cancer
• Watch and wait

• circumferential margin
• rectal cancer
• single-incision laparoscopic surgery
• total mesorectal excision
• tumor-specific mesorectal excision

• Rectal surgery
• complications
• laparoscopic

• Anastomosis
• Laparoscopic
• Rectal cancer

• Laparoscopic rectum cancer surgery
• laparoscopic single access-surgery
• laparoscopic single-port surgery

• Anastomotic leakage
• laparoscopic surgery
• rectal cancer
• recurrence

Most patients who develop rectal cancer present with locoregionally advanced (T3 or node-positive) disease. The standard management of locoregionally advanced rectal cancer is neoadjuvant concurrent chemoradiotherapy (nCRT), followed by radical resection (low-anterior resection or abdominoperineal resection with total mesorectal excision). Approximately 15% of patients can have a pathologic complete response (pCR) at the time of surgery, indicating that some patients can have no detectable residual disease after nCRT. The actual benefit of surgery in this group of patients is unclear. It is possible that omission of surgery in these patients, termed selective nonoperative management, can limit the toxicities associated with standard, multimodal combined modality therapy without compromising disease control. In this review, we discuss the clinical experiences to date using selective nonoperative management and various attempts at escalation of nCRT to improve the number of patients who have a pCR. We also explore several clinical, laboratory, imaging, histopathologic, and genetic biomarkers that have been tested as tools to predict which patients are most likely to have a pCR after nCRT.

• chemoradiotherapy
• nonoperative management
• organ preservation
• rectal cancer
• total mesorectal excision

• Rectal cancer
• Robotic TME
• Robotic assisted colorectal surgery
• Robotic surgery
• Robotics

While laparoscopic colon surgery has been established to some degree over this decade, laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field, the lack of precise anatomy of the pelvis, immature procedures of rectal transaction and so on. On the other hand, maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness. However, some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes. This review article discusses how to keep a clear operative field, removing normally existing abdominal structures, and how to transact the rectum and restore the discontinuity based on anatomical investigations. According to this review, laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far, actually entering a new era.

• Laparoscopic surgery
• Rectum
• Anatomy
• Plane
• Reconstruction
• Double stapling technique
• Anal preservation

At present time, there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions, lower morbidity rate and earlier recovery compared to open surgery. Technical limitations and a steep learning curve have limited the wide application of mini-invasive surgery for rectal cancer. The present article discusses the current status of laparoscopic resection for rectal cancer. A review of the more recent retrospective, prospective and randomized controlled trial (RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed. A particular emphasis was dedicated to mid and low rectal cancers. Few prospective and RCT trials specifically addressing laparoscopic rectal cancer resection are currently available in the literature. Improved short-term outcomes in term of lesser intraoperative blood loss, reduced analgesic requirements and a shorter hospital stay have been demonstrated. Concerns have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential margin. This data however was not confirmed by other prospective comparative studies. Moreover, a similar local recurrence rate has been reported in RCT and comparative series. Similar findings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any definitive conclusions. On the basis of available data in the literature, the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local recurrence. With respect to long-term survival, a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue.

• Postoperative complications
• Recurrence rate
• Transanal endoscopic microsurgery
• Robotics
• Long-term outcome
• Prognosis
• Rectal cancer
• Laparoscopy

• Learning curve
• Robotic colorectal surgery
• Safety

• Laparoscopy
• approaches
• rectal cancer
• techniques