Surgical Endoscopy

, Volume 25, Issue 8, pp 2423–2440 | Cite as

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

  • R. Siegel
  • M. A. Cuesta
  • E. Targarona
  • F. G. Bader
  • M. Morino
  • R. Corcelles
  • A. M. Lacy
  • L. Påhlman
  • E. Haglind
  • K. Bujko
  • H. P. Bruch
  • M. M. Heiss
  • M. Eikermann
  • E. A. M. NeugebauerEmail author



The laparoscopic approach is increasingly applied in colorectal surgery. Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent long-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic rectal cancer surgery might be efficacious, but indications and limitations are not clearly defined. Therefore, the European Association for Endoscopic Surgery (EAES) has developed this clinical practice guideline.


An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. The expert panel constituted for a consensus development conference in May 2010. Thereafter, the recommendations were presented at the annual congress of the EAES in Geneva in June 2010 in a plenary session. A second consensus process (Delphi process) of the recommendations with the explanatory text was necessary due to the changes after the consensus conference.


Laparoscopic surgery for extraperitoneal (mid- and low-) rectal cancer is feasible and widely accepted. The laparoscopic approach must offer the same quality of surgical specimen as in open surgery. Short-term outcomes such as bowel function, surgical-site infections, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not inferior to the open in terms of disease-free survival, overall survival or local recurrence. Laparoscopic pelvic dissection may impair genitourinary and sexual function after rectal resection, like in open surgery.


Laparoscopic surgery for mid- and low-rectal cancer can be recommended under optimal conditions. Still, most level 1 evidence is for colon cancer surgery rather than rectal cancer. Upcoming results from large randomised trials are awaited to strengthen the evidence for improved short-term results and equal long-term results in comparison with the open approach.


Guidelines Laparoscopy Minimally invasive surgery Rectal cancer 



The supportive work of Melanie Rezvani, Christoph Mosch and Tim Mathes, Institute for Research in Operative Medicine (IFOM, Witten/Herdecke University) is highly appreciated.


Authors R.S., M.A.C., E.T., F.G.B., M.M., R.C., L.P., E.H., K.B. H.P.B., M.M.H., M.E., and E.A.M.N. have no conflicts of interest or financial ties to disclose. Author A.M.L. is a consultant for Covidien and for Olympus Medical.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • R. Siegel
    • 1
  • M. A. Cuesta
    • 2
  • E. Targarona
    • 3
  • F. G. Bader
    • 4
  • M. Morino
    • 5
  • R. Corcelles
    • 6
  • A. M. Lacy
    • 6
  • L. Påhlman
    • 7
  • E. Haglind
    • 8
  • K. Bujko
    • 9
  • H. P. Bruch
    • 4
  • M. M. Heiss
    • 1
  • M. Eikermann
    • 10
  • E. A. M. Neugebauer
    • 10
    Email author
  1. 1.Department of Visceral, Vascular, and Transplantation Surgery, Faculty of HealthWitten/Herdecke University, Campus Cologne-MerheimCologneGermany
  2. 2.Department of SurgeryVU University Medical CentreAmsterdamThe Netherlands
  3. 3.Service of Surgery, Hospital de Sant PauUniversity Autonomous of BarcelonaBarcelonaSpain
  4. 4.Department of SurgeryUniversity of Schleswig-Holstein, Campus LübeckLübeckGermany
  5. 5.Digestive Surgery and Center for Minimally Invasive Surgery, Department of SurgeryUniversity of TurinTurinItaly
  6. 6.Department of Gastrointestinal Surgery, Hospital ClinicUniversity of BarcelonaBarcelonaSpain
  7. 7.Department of Surgical Science, Akademiska SjukhusetUniversity of UppsalaUppsalaSweden
  8. 8.Department of SurgerySahlgrenska University Hospital/ÖstraGöteborgSweden
  9. 9.Department of RadiotherapyMaria Sklodowska-Curie Memorial Cancer CentreWarsawPoland
  10. 10.Institute for Research in Operative Medicine (IFOM), Chair for Surgical Research, Faculty of HealthWitten/Herdecke University, Campus Cologne-MerheimKölnGermany

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