Perini D, Cammelli F, Scheiterle M, Martellucci J, Di Bella A, Bergamini C, Prosperi P, Giordano A. Beyond total mesorectal excision: The emerging role of minimally invasive surgery for locally advanced rectal cancer. World J Gastrointest Surg 2024; 16(8): 2382-2385 [PMID: 39220075 DOI: 10.4240/wjgs.v16.i8.2382]
Corresponding Author of This Article
Alessio Giordano, MD, Doctor, Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Largo A. Brambilla 3, Firenze 50137, Italy. alessio.giordano8@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2382-2385 Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2382
Beyond total mesorectal excision: The emerging role of minimally invasive surgery for locally advanced rectal cancer
Davina Perini, Francesca Cammelli, Maximilian Scheiterle, Jacopo Martellucci, Annamaria Di Bella, Carlo Bergamini, Paolo Prosperi, Alessio Giordano
Davina Perini, Francesca Cammelli, Maximilian Scheiterle, Jacopo Martellucci, Annamaria Di Bella, Carlo Bergamini, Paolo Prosperi, Alessio Giordano, Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
Author contributions: Perini D designed the overall concept; Perini D, Cammelli F, and Giordano A contributed to the design of the manuscript and the writing; Scheiterle M, Martellucci J, and Di Bella A contributed to the discussion and the editing; Perini D, Bergamini C, and Prosperi P contributed to the review of literature; All authors contributed to this paper.
Conflict-of-interest statement: The authors certify that there is no actual or potential conflict of interest in relation to this editorial. They state that there are no financial interests or connections, direct or indirect, or other situations that might raise the question of bias in the work reported or the conclusions, implications, or opinions stated. This includes pertinent commercial or other sources of funding for the individual author(s) or the associated department(s) or organization(s), personal relationships, or direct academic competition.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessio Giordano, MD, Doctor, Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Largo A. Brambilla 3, Firenze 50137, Italy. alessio.giordano8@gmail.com
Received: March 13, 2024 Revised: May 7, 2024 Accepted: June 5, 2024 Published online: August 27, 2024 Processing time: 156 Days and 0.3 Hours
Abstract
Multivisceral resection and/or pelvic exenteration represents the only potential curative treatment for locally advanced rectal cancer (LARC); however, it poses significant technical challenges, which account for the high risk of morbidity and mortality associated with the procedure. As complete histopathologic resection is the most important determinant of patient outcomes, LARC often requires an extended resection beyond the total mesorectal excision plane to obtain clear resection margins. In an era when laparoscopic surgery and robot-assisted surgery are becoming commonplace, the optimal approach to extensive pelvic interventions remains controversial. However, acceptance of the suitability of minimally invasive surgery is slowly gaining traction. Nonetheless, there is still a lack of evidence in the literature about minimally invasive approaches in multiple and extensive surgical resections, highlighting the need for research studies to explore, validate, and develop this issue. This editorial aims to provide a critical overview of the currently available applications and challenges of minimally invasive abdominopelvic surgery for LARC. Furthermore, we discuss recent developments in the field of robotic surgery for LARC, with a specific focus on new innovations and emerging frontiers.
Core Tip: Locally advanced rectal cancer (LARC) poses a distinctive challenge for surgical resection. It is of paramount importance to define the extent of surgery and to decide whether to perform a minimally invasive procedure. Minimally invasive surgery provides adequate guidance for the surgeon to achieve complex and multiple resections with clear margins; however, no consensus regarding the optimal approach exists. Here, we assess the evidence and emerging role of robotic assistance in multivisceral pelvic exenteration beyond total mesorectal excision for LARC, where difficult operative challenges and ergonomics might be encountered.
