Skip to main content
SpringerLink
Log in

Current Status of Minimally Invasive Surgery for Rectal Cancer

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Recent randomized controlled data have shown possible limitations to laparoscopic treatment of rectal cancer. The retrospective data, used as the basis for designing the trials, and which showed no problems with the technique, are discussed. The design of the randomized trials is discussed relative to the future meta-analysis of the recent data. The implications of the current findings on practice are discussed as surgeons try to adjust their practice to the new findings. The possible next steps for clinical and research innovations are put into perspective as new technology is considered to compensate for newly identified limitations in the laparoscopic treatment of rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Senagore AJ. Adoption of Laparoscopic Colorectal Surgery: It Was Quite a Journey. Clin Colon Rectal Surg. 2015;28(3):131-4.

    Article  PubMed  Google Scholar 

  2. Yeo H, Niland J, Milne D, ter Veer A, Bekaii-Saab T, Farma JM et al. Incidence of minimally invasive colorectal cancer surgery at National Comprehensive Cancer Network centers. J Natl Cancer Inst. 2015;107(1):362.

    Article  PubMed  Google Scholar 

  3. Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A et al. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg. 2007;142(3):298-303.

    Article  PubMed  Google Scholar 

  4. Wilson MZ, Hollenbeak CS, Stewart DB. Laparoscopic colectomy is associated with a lower incidence of postoperative complications than open colectomy: a propensity score-matched cohort analysis. Colorectal Dis. 2014;16(5):382-9.

    Article  CAS  PubMed  Google Scholar 

  5. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg. 2008;248(1):1-7.

    Article  PubMed  Google Scholar 

  6. Whiteford MH, Denk PM, Swanstrom LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc. 2007;21(10):1870-4.

    Article  CAS  PubMed  Google Scholar 

  7. Marks J, Nassif G, Schoonyoung H, DeNittis A, Zeger E, Mohiuddin M et al. Sphincter-sparing surgery for adenocarcinoma of the distal 3 cm of the true rectum: results after neoadjuvant therapy and minimally invasive radical surgery or local excision. Surg Endosc. 2013;27(12):4469-77.

    Article  PubMed  Google Scholar 

  8. Fajardo AD, Hunt SR, Fleshman JW, Mutch MG. Video. Transanal single-port low anterior resection in a cadaver model. Surg Endosc. 2010;24(7):1765.

    Article  PubMed  Google Scholar 

  9. Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B et al. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. J Am Coll Surg. 2015;221(2):415-23.

    Article  PubMed  Google Scholar 

  10. Clinical Outcomes of Surgical Therapy Study G. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050-9.

    Article  Google Scholar 

  11. Wu JS, Birnbaum EH, Fleshman JW. Early experience with laparoscopic abdominoperineal resection. Surg Endosc. 1997;11(5):449-55.

    Article  CAS  PubMed  Google Scholar 

  12. Cima RR, Pendlimari R, Holubar SD, Pattana-Arun J, Larson DW, Dozois EJ et al. Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients. Dis Colon Rectum. 2011;54(9):1076-81.

    Article  PubMed  Google Scholar 

  13. Martling A, Holm T, Rutqvist LE, Johansson H, Moran BJ, Heald RJ et al. Impact of a surgical training programme on rectal cancer outcomes in Stockholm. Br J Surg. 2005;92(2):225-9.

    Article  CAS  PubMed  Google Scholar 

  14. Kim CH, Kim HJ, Huh JW, Kim YJ, Kim HR. Learning curve of laparoscopic low anterior resection in terms of local recurrence. J Surg Oncol. 2014;110(8):989-96.

    Article  PubMed  Google Scholar 

  15. Weiser MR, Milsom JW. Laparoscopic total mesorectal excision with autonomic nerve preservation. Semin Surg Oncol. 2000;19(4):396-403.

    Article  CAS  PubMed  Google Scholar 

  16. Reissman P, Cohen S, Weiss EG, Wexner SD. Laparoscopic colorectal surgery: ascending the learning curve. World J Surg. 1996;20(3):277-81; discussion 82.

    Article  CAS  PubMed  Google Scholar 

  17. Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart RW, Jr. The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg. 1997;132(1):41-4; discussion 5.

    Article  CAS  PubMed  Google Scholar 

  18. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg. 2005;242(1):83-91.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg. 2009;13(2):275-81.

    Article  PubMed  Google Scholar 

  20. Bege T, Lelong B, Esterni B, Turrini O, Guiramand J, Francon D et al. The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer: lessons drawn from a single institution’s experience. Ann Surg. 2010;251(2):249-53.

    Article  PubMed  Google Scholar 

  21. Larson DW, Marcello PW, Larach SW, Wexner SD, Park A, Marks J et al. Surgeon volume does not predict outcomes in the setting of technical credentialing: results from a randomized trial in colon cancer. Ann Surg. 2008;248(5):746-50.

    Article  PubMed  Google Scholar 

  22. Yamamoto S, Watanabe M, Hasegawa H, Kitajima M. Prospective evaluation of laparoscopic surgery for rectosigmoidal and rectal carcinoma. Dis Colon Rectum. 2002;45(12):1648-54.

    Article  PubMed  Google Scholar 

  23. Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J. Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg. 2003;90(4):445-51.

    Article  CAS  PubMed  Google Scholar 

  24. Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg. 2003;237(3):335-42.

    PubMed  PubMed Central  Google Scholar 

  25. Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW. Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum. 2003;46(8):1047-53.

    Article  PubMed  Google Scholar 

  26. Feliciotti F, Guerrieri M, Paganini AM, De Sanctis A, Campagnacci R, Perretta S et al. Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc. 2003;17(10):1530-5.

    Article  CAS  PubMed  Google Scholar 

  27. Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc. 2004;18(2):281-9.

    Article  CAS  PubMed  Google Scholar 

  28. Wu WX, Sun YM, Hua YB, Shen LZ. Laparoscopic versus conventional open resection of rectal carcinoma: A clinical comparative study. World J Gastroenterol. 2004;10(8):1167-70.

    PubMed  PubMed Central  Google Scholar 

  29. Dulucq JL, Wintringer P, Stabilini C, Mahajna A. Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc. 2005;19(11):1468-74.

    Article  PubMed  Google Scholar 

  30. Morino M, Giraudo G. Laparoscopic total mesorectal excision-the Turin experience. Recent Results Cancer Res. 2005;165:167-79.

    Article  CAS  PubMed  Google Scholar 

  31. Fleshman JW, Wexner SD, Anvari M, LaTulippe JF, Birnbaum EH, Kodner IJ et al. Laparoscopic vs. open abdominoperineal resection for cancer. Dis Colon Rectum. 1999;42(7):930-9.

    Article  CAS  PubMed  Google Scholar 

  32. Leung KL, Kwok SP, Lau WY, Meng WC, Chung CC, Lai PB et al. Laparoscopic-assisted abdominoperineal resection for low rectal adenocarcinoma. Surg Endosc. 2000;14(1):67-70.

    Article  CAS  PubMed  Google Scholar 

  33. Poulin EC, Schlachta CM, Gregoire R, Seshadri P, Cadeddu MO, Mamazza J. Local recurrence and survival after laparoscopic mesorectal resection forrectal adenocarcinoma. Surg Endosc. 2002;16(6):989-95.

  34. Scheidbach H, Schneider C, Konradt J, Barlehner E, Kohler L, Wittekind C et al. Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc. 2002;16(1):7-13.

    Article  CAS  PubMed  Google Scholar 

  35. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061-8.

    Article  PubMed  Google Scholar 

  36. Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B et al. Converted laparoscopic colorectal surgery. Surg Endosc. 2001;15(8):827-32.

    Article  CAS  PubMed  Google Scholar 

  37. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006;13(3):413-24.

    Article  PubMed  Google Scholar 

  38. Breukink S, Pierie J, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. 2006(4):CD005200.

    PubMed  Google Scholar 

  39. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev. 2008;34(6):498-504.

    Article  PubMed  Google Scholar 

  40. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 2008(2):CD003432.

    PubMed  Google Scholar 

  41. Baik SH, Gincherman M, Mutch MG, Birnbaum EH, Fleshman JW. Laparoscopic vs open resection for patients with rectal cancer: comparison of perioperative outcomes and long-term survival. Dis Colon Rectum. 2011;54(1):6-14.

    Article  PubMed  Google Scholar 

  42. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA. 2015;314(13):1346-55.

    Article  CAS  PubMed  Google Scholar 

  43. Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA. 2015;314(13):1356-63.

    Article  CAS  PubMed  Google Scholar 

  44. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372(14):1324-32.

    Article  CAS  PubMed  Google Scholar 

  45. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(7):767-74.

    Article  PubMed  Google Scholar 

  46. Baek SJ, Al-Asari S, Jeong DH, Hur H, Min BS, Baik SH et al. Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc. 2013;27(11):4157-63.

    Article  PubMed  Google Scholar 

  47. Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Lee KY et al. Short and long-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: a case-matched retrospective study. Medicine (Baltimore). 2015;94(11):e522.

    Article  Google Scholar 

  48. Fernandez R, Anaya DA, Li LT, Orcutt ST, Balentine CJ, Awad SA et al. Laparoscopic versus robotic rectal resection for rectal cancer in a veteran population. Am J Surg. 2013;206(4):509-17.

    Article  PubMed  Google Scholar 

  49. Ghezzi TL, Luca F, Valvo M, Corleta OC, Zuccaro M, Cenciarelli S et al. Robotic versus open total mesorectal excision for rectal cancer: comparative study of short and long-term outcomes. Eur J Surg Oncol. 2014;40(9):1072-9.

    Article  CAS  PubMed  Google Scholar 

  50. Levic K, Donatsky AM, Bulut O, Rosenberg J. A Comparative Study of Single-Port Laparoscopic Surgery Versus Robotic-Assisted Laparoscopic Surgery for Rectal Cancer. Surg Innov. 2015;22(4):368-75.

    Article  PubMed  Google Scholar 

  51. Xiong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg. 2015;19(3):516-26.

    Article  PubMed  Google Scholar 

  52. Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R et al. An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis. 2012;27(2):233-41.

    Article  PubMed  Google Scholar 

  53. Speicher PJ, Englum BR, Ganapathi AM, Nussbaum DP, Mantyh CR, Migaly J. Robotic Low Anterior Resection for Rectal Cancer: A National Perspective on Short-term Oncologic Outcomes. Ann Surg. 2015;262(6):1040-5.

    Article  PubMed  Google Scholar 

  54. Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T et al. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. 2014;4:CD005200.

    PubMed  Google Scholar 

Download references

Acknowledgments

The author wishes to thank Margaret Hinshelwood, PhD for her assistance with the final manuscript preparation. The author received no grant support for this work.

Author information

Authors and Affiliations

  1. Department of Surgery, Baylor University Medical Center, Dallas, TX, USA

    James Fleshman

  2. Texas A&M University, College Station, TX, USA

    James Fleshman

Authors
  1. James Fleshman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James Fleshman.

Additional information

The objectives of this manuscript are to

1. Discuss the data surrounding minimally invasive treatment of rectal cancer.

2. Delineate the essential anatomy and dissection techniques for rectal cancer surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fleshman, J. Current Status of Minimally Invasive Surgery for Rectal Cancer. J Gastrointest Surg 20, 1056–1064 (2016). https://doi.org/10.1007/s11605-016-3085-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-016-3085-3

Keywords

Search

Navigation