Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2020; 26(30): 4394-4414
Published online Aug 14, 2020. doi: 10.3748/wjg.v26.i30.4394
Role of minimally invasive surgery for rectal cancer
Kurt A Melstrom, Andreas M Kaiser
Kurt A Melstrom, Andreas M Kaiser, Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010-3000, United States
Author contributions: Melstrom KA and Kaiser AM contributed to concept, manuscript writing/editing.
Conflict-of-interest statement: Dr. Kaiser reports personal fees from Intuitive Surgical, other from McGraw-Hill Publisher, other from Uptodate, outside the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Andreas M Kaiser, FACS, MD, Chief Physician, Full Professor, Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, 1500 E Duarte Road, Suite MALP 2230, Duarte, CA 91010-3000, United States.
Received: March 30, 2020
Peer-review started: March 30, 2020
First decision: April 29, 2020
Revised: May 20, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 14, 2020

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.