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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2016; 22(2): 718-726
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.718
Technical feasibility of laparoscopic extended surgery beyond total mesorectal excision for primary or recurrent rectal cancer
Takashi Akiyoshi
Takashi Akiyoshi, Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
Author contributions: Akiyoshi T analyzed the literature and wrote the manuscript.
Conflict-of-interest statement: The author has no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takashi Akiyoshi, MD, PhD, Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan. takashi.akiyoshi@jfcr.or.jp
Telephone: +81-3-35200111 Fax: +81-3-35200141
Received: May 18, 2015
Peer-review started: May 20, 2015
First decision: August 26, 2015
Revised: September 18, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: January 14, 2016
Abstract

Relatively little is known about the oncologic safety of laparoscopic surgery for advanced rectal cancer. Recently, large randomized clinical trials showed that laparoscopic surgery was not inferior to open surgery, as evidenced by survival and local control rates. However, patients with T4 tumors were excluded from these trials. Technological advances in the instrumentation and techniques used by laparoscopic surgery have increased the use of laparoscopic surgery for advanced rectal cancer. High-definition, illuminated, and magnified images obtained by laparoscopy may enable more precise laparoscopic surgery than open techniques, even during extended surgery for T4 or locally recurrent rectal cancer. To date, the quality of evidence regarding the usefulness of laparoscopy for extended surgery beyond total mesorectal excision has been low because most studies have been uncontrolled series, with small sample sizes, and long-term data are lacking. Nevertheless, laparoscopic extended surgery for rectal cancer, when performed by specialized laparoscopic colorectal surgeons, has been reported safe in selected patients, with significant advantages, including a clear visual field and less blood loss. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer.

Keywords: Rectal cancer, Total mesorectal excision, Laparoscopic surgery, Extended surgery, Lateral pelvic lymph node dissection, Pelvic exenteration

Core tip: Relatively little is known about the efficacy and safety of laparoscopic extended surgery beyond total mesorectal excision for primary or locally recurrent rectal cancer. However, some experienced surgeons have reported the usefulness of laparoscopic surgery for such challenging cases. This review summarizes current knowledge on laparoscopic extended surgery beyond total mesorectal excision.