Role of minimally invasive surgery for rectal cancer

Abstract

Rectal cancer is one of the most common malignancies worldwide. Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy (total mesorectal excision). This has traditionally been performed transabdominally through an open incision. Over the last thirty years, minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach. There are currently three resective modalities that complement the traditional open operation: (1) Laparoscopic surgery; (2) Robotic surgery; and (3) Transanal total mesorectal excision. In addition, there are several platforms to carry out transluminal local excisions (without lymphadenectomy). Evidence on the various modalities is of mixed to moderate quality. It is unreasonable to expect a randomized comparison of all options in a single trial. This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks, recovery and complications, oncological and functional outcomes.

Keywords: Rectal cancer; Minimally invasive surgery; Laparoscopic surgery; Robotic surgery; Transanal total mesorectal excision; Transanal minimally invasive surgery

Core tip: Rectal cancer is one of the most complex diseases as it combines oncological, anatomical, and functional challenges with a variety of technical and multimodality treatment options. While open surgery was long considered the surgical gold standard, less invasive approaches have evolved. These newer technologies have attractive advantages, however their overall benefit and risk analysis in the short and long run and their specific role for rectal cancer remain controversial and a matter of further research.