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Minimally Invasive Surgery for Rectal Cancer: Current Trends

  • Surgery and Surgical Innovations in Colorectal Cancer (S Huerta, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of the Review

The literature regarding minimally invasive surgical approaches to rectal adenocarcinoma is reviewed, and techniques introduced over recent decades are assessed for oncological and patient-centered outcomes.

Recent Findings

Total mesorectal excision (TME) is the gold standard for surgical treatment of rectal adenocarcinoma, and while laparoscopic TME is safe and feasible, with acceptable oncologic outcomes, its non-inferiority with regard to completeness of TME specimen when compared to open surgery could not be established in two recent randomized trials. Long-term follow-up for these trials is pending with regard to ultimate oncologic outcomes. Robotic TME is also safe and feasible when performed by experienced surgeons, but has high costs, and results of the only randomized trial comparing the technique to laparoscopy are yet to be published. Laparoscopic and robotic approaches appear to offer short-term benefits in patient recovery and quality of life. The latest innovation is transanal TME (TaTME). This is performed at select centers, and early on, has been associated with acceptable resection quality and short-term outcomes. Organ-preserving transanal and endoscopic resections for early-stage disease have acceptable results, and a non-operative/watch-and-wait strategy may be appropriate in selected patients with a complete clinical response.

Summary

There are multiple surgical options for rectal adenocarcinoma, depending on patient and disease characteristics. In the appropriate setting, minimally invasive approaches to TME offer short-term benefits to patients and acceptable oncologic results. Organ-preserving strategies in selected patients may avoid morbidity associated with radical resection.

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Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA

    Aaron C. Saunders, Rupen Shah & Steven Nurkin

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  1. Aaron C. Saunders
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Correspondence to Steven Nurkin.

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Aaron C. Saunders, Rupen Shah, and Steven Nurkin declare that they have no conflicts of interest.

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This article is part of the Topical Collection on Surgery and Surgical Innovations in Colorectal Cancer

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Saunders, A.C., Shah, R. & Nurkin, S. Minimally Invasive Surgery for Rectal Cancer: Current Trends. Curr Colorectal Cancer Rep 13, 136–143 (2017). https://doi.org/10.1007/s11888-017-0357-6

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