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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. GLOBOCAN IARC 2008: country fast stat [Internet]. http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=900#BOTH. Cited 1 Mar 2011

  2. Micheli A (2002) Cancer prevalence in European registry areas. Ann Oncol 13(6):840–865

    Article  PubMed  CAS  Google Scholar 

  3. The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059

    Article  Google Scholar 

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

  5. Buunen M, Veldkamp R, Hop WCJ, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52

    Article  PubMed  CAS  Google Scholar 

  6. Levels of Evidence [Internet] (2011). http://www.cebm.net/index.aspx?o=1025. Cited 1 Mar 2011

  7. Council of Europe (2002) Developing a methodology for drawing up guidelines on best medical practice. Council of Europe Publishing, Strasbourg, pp 46–47. ISBN 92-871-4788-4

  8. Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CFB, Askham J, Marteau T (1998) Consensus development methods, and their use in clinical guideline development. Health Technol Assess 2(3):i–iv, 1–88

    Google Scholar 

  9. Nicholls RJ, Masona Y, Morson BC, Dixona K, Fry IK (1982) The clinical staging of rectal cancer. Br J Surg 69(7):404–409

    Article  PubMed  CAS  Google Scholar 

  10. Schoellhammer HF, Gregorian AC, Sarkisyan GG, Petrie BA (2008) How important is rigid proctosigmoidoscopy in localizing rectal cancer? Am J Surg 196(6):904–908 (discussion 908)

    Article  PubMed  Google Scholar 

  11. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, Dixon MF, Quirke P (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344(8924):707–711

    Article  PubMed  CAS  Google Scholar 

  12. Lahaye MJ, Engelen SME, Nelemans PJ, Beets GL, van de Velde CJH, van Engelshoven JMA, Beets-Tan RGH (2005) Imaging for predicting the risk factors—the circumferential resection margin and nodal disease—of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 26(4):259–268

    Article  PubMed  CAS  Google Scholar 

  13. Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PMM, Stoker J (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 232(3):773–783

    Article  PubMed  Google Scholar 

  14. Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90(3):355–364

    Article  PubMed  CAS  Google Scholar 

  15. MERCURY Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ (Clinical Res Ed) 333(7572):779

    Google Scholar 

  16. Mathur P, Smith JJ, Ramsey C, Owen M, Thorpe A, Karim S, Burke C, Ramesh S, Dawson PM (2003) Comparison of CT and MRI in the pre-operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI. Colorectal Dis 5(5):396–401

    Article  PubMed  CAS  Google Scholar 

  17. Mauchley DC, Lynge DC, Langdale LA, Stelzner MG, Mock CN, Billingsley KG (2005) Clinical utility and cost-effectiveness of routine preoperative computed tomography scanning in patients with colon cancer. Am J Surg 189(5):512–517 (discussion 517)

    Article  PubMed  Google Scholar 

  18. Barillari P, Ramacciato G, De Angelis R, Gozzo P, Indinnimeo M, Valabrega S, Aurello P, Fegiz G (1990) Effect of preoperative colonoscopy on the incidence of synchronous and metachronous neoplasms. Acta Chirurg Scand 156(2):163–166

    CAS  Google Scholar 

  19. Chen HS, Sheen-Chen SM (2000) Synchronous and “early” metachronous colorectal adenocarcinoma: analysis of prognosis and current trends. Dis Colon Rectum 43(8):1093–1099

    Article  PubMed  CAS  Google Scholar 

  20. Copel L, Sosna J, Kruskal JB, Raptopoulos V, Farrell RJ, Morrin MM (2007) CT colonography in 546 patients with incomplete colonoscopy. Radiology 244(2):471–478

    Article  PubMed  Google Scholar 

  21. Coccetta M, Migliaccio C, La Mura F, Farinella E, Galanou I, Delmonaco P, Spizzirri A, Napolitano V, Cattorini L, Milani D, Cirocchi R, Sciannameo F (2009) Virtual colonoscopy in stenosing colorectal cancer. Ann Surg Innov Res 3:11

    Article  PubMed  Google Scholar 

  22. Duffy MJ, van Dalen A, Haglund C, Hansson L, Holinski-Feder E, Klapdor R, Lamerz R, Peltomaki P, Sturgeon C, Topolcan O (2007) Tumour markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines for clinical use. Eur J Cancer 43(9):1348–1360

    Article  PubMed  CAS  Google Scholar 

  23. Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, Somerfield MR, Hayes DF, Bast RC (2006) ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 24(33):5313–5327

    Article  PubMed  CAS  Google Scholar 

  24. Park YJ, Youk EG, Choi HS, Han SU, Park KJ, Lee KU, Choe KJ, Park JG (1999) Experience of 1446 rectal cancer patients in Korea and analysis of prognostic factors. Int J Colorectal Dis 14(2):101–106

    Article  PubMed  Google Scholar 

  25. Park YJ, Park KJ, Park JG, Lee KU, Choe KJ, Kim JP (1999) Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg 23(7):721–726

    Article  PubMed  CAS  Google Scholar 

  26. Valentini V, Aristei C, Glimelius B, Minsky BD, Beets-Tan R, Borras JM, Haustermans K, Maingon P, Overgaard J, Pahlman L, Quirke P, Schmoll H-J, Sebag-Montefiore D, Taylor I, Van Cutsem E, Van de Velde C, Cellini N, Latini P (2009) Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Radiat Oncol 92(2):148–163

    Article  Google Scholar 

  27. (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 336(14):980–987

  28. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, Krieken JH, van Leer JW, van de Velde CJ (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646

    Article  PubMed  CAS  Google Scholar 

  29. Cammà C, Giunta M, Fiorica F, Pagliaro L, Craxì A, Cottone M (2000) Preoperative radiotherapy for resectable rectal cancer: A meta-analysis. JAMA 284(8):1008–1015

    Google Scholar 

  30. Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U (2005) Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23(24):5644–5650

    Article  PubMed  Google Scholar 

  31. Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133(8):894–899

    Article  PubMed  CAS  Google Scholar 

  32. Peeters KCMJ, Marijnen CAM, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlman L, Glimelius B, Leer JW, van de Velde CJH (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701

    Article  PubMed  Google Scholar 

  33. Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820

    Article  PubMed  Google Scholar 

  34. Frykholm GJ, Glimelius B, Påhlman L (1993) Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 36(6):564–572

    Article  PubMed  CAS  Google Scholar 

  35. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens J-H, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740

    Article  PubMed  CAS  Google Scholar 

  36. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93(10):1215–1223

    Article  PubMed  CAS  Google Scholar 

  37. McLachlan S, Fisher R, McClure B, Beresford J, McKendrick J, Mackay J, Solomon M, Burmeister B, Hartopeanu C, Ngan S (2008) A comparison of quality of life in patients with T3 rectal cancer receiving short course versus long course preoperative radiation. A Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). J Clin Oncol (Meeting Abstracts) 26(15202s)

  38. Siegel R, Burock S, Wernecke K-D, Kretzschmar A, Dietel M, Loy V, Koswig S, Budach V, Schlag PM (2009) Preoperative short-course radiotherapy versus combined radiochemotherapy in locally advanced rectal cancer: a multi-centre prospectively randomised study of the Berlin Cancer Society. BMC Cancer 9:50

    Article  PubMed  CAS  Google Scholar 

  39. O’Connell MJ, Martenson JA, Wieand HS, Krook JE, Macdonald JS, Haller DG, Mayer RJ, Gunderson LL, Rich TA (1994) Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 331(8):502–507

    Article  PubMed  Google Scholar 

  40. Meta-analysis Group in Cancer (1998) Efficacy of intravenous continuous infusion of fluorouracil compared with bolus administration in advanced colorectal cancer. J Clin Oncol 16(1):301–308

    Google Scholar 

  41. Kim JS, Kim JS, Cho MJ, Yoon WH, Song KS (2006) Comparison of the efficacy of oral capecitabine versus bolus 5-FU in preoperative radiotherapy of locally advanced rectal cancer. J Korean Med Sci 21(1):52–57

    Article  PubMed  CAS  Google Scholar 

  42. Marijnen CAM, Leer JWH, Putter H, Kapiteijn E, van Krieken JHJM, Noordijk EM, van de Velde CJH (2001) Interval between preoperative radiotherapy and surgery influences postoperative mortality in rectal cancer patients: the sooner the better. Eur J Cancer 37(Suppl 6):S273

    Article  Google Scholar 

  43. Pettersson D, Cedermark B, Holm T, Radu C, Påhlman L, Glimelius B, Martling A (2010) Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg 97(4):580–587

    Article  PubMed  CAS  Google Scholar 

  44. Neugebauer EAM, Sauerland S, Fingerhut A (2006) EAES guidelines for endoscopic surgery: twelve years evidence-based surgery in Europe. Springer, Berlin

    Google Scholar 

  45. Guenaga KKFG, Matos D, Wille-Jørgensen P (2009) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev (Online) (1):CD001544

  46. Slim K, Vicaut E, Launay-Savary M-V, Contant C, Chipponi J (2009) Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249(2):203–209

    Article  PubMed  Google Scholar 

  47. Zhu QD, Zhang QY, Zeng QQ, Yu ZP, Tao CL, Yang WJ (2010) Efficacy of mechanical bowel preparation with polyethylene glycol in prevention of postoperative complications in elective colorectal surgery: a meta-analysis. Int J Colorectal Dis 25(2):267–275

    Article  PubMed  Google Scholar 

  48. Ulrich AB, Seiler C, Rahbari N, Weitz J, Büchler MW (2009) Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum 52(3):412–418

    Article  PubMed  Google Scholar 

  49. Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246(2):207–214

    Article  PubMed  Google Scholar 

  50. Van’t Sant HP, Weidema WF, Hop WCJ, Oostvogel HJM, Contant CME (2010) The influence of mechanical bowel preparation in elective lower colorectal surgery. Ann Surg 251(1):59–63

    Article  PubMed  Google Scholar 

  51. Bretagnol F, Alves A, Ricci A, Valleur P, Panis Y (2007) Rectal cancer surgery without mechanical bowel preparation. Br J Surg 94(10):1266–1271

    Article  PubMed  CAS  Google Scholar 

  52. Schwenk W (2009) [Fast track rehabilitation in visceral surgery]. Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen 80(8):690–701

    PubMed  CAS  Google Scholar 

  53. Levy BF, Tilney HS, Dowson HMP, Rockall TA (2010) A systematic review of postoperative analgesia following laparoscopic colorectal surgery. Colorectal Dis 12(1):5–15

    Article  PubMed  CAS  Google Scholar 

  54. McCarthy GC, Megalla SA, Habib AS (2010) Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs 70(9):1149–1163

    Article  PubMed  CAS  Google Scholar 

  55. White PF, Kehlet H (2010) Improving postoperative pain management: what are the unresolved issues? Anesthesiology 112(1):220–225

    Google Scholar 

  56. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen P-E, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238(5):641–648

    Article  PubMed  Google Scholar 

  57. Holte K, Kehlet H (2006) Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg 202(6):971–989

    Article  PubMed  Google Scholar 

  58. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 359(9320):1812–1818

    Article  PubMed  Google Scholar 

  59. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I (2005) Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 103(1):25–32

    Article  PubMed  Google Scholar 

  60. Rahbari NN, Zimmermann JB, Schmidt T, Koch M, Weigand MA, Weitz J (2009) Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg 96(4):331–341

    Article  PubMed  CAS  Google Scholar 

  61. Nelson RL, Glenny AM, Song F (2009) Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev (Online) (1):CD001181

  62. Lassen K, Kjaeve J, Fetveit T, Tranø G, Sigurdsson HK, Horn A, Revhaug A (2008) Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg 247(5):721–729

    Article  PubMed  Google Scholar 

  63. Lewis SJ, Egger M, Sylvester PA, Thomas S (2001) Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ (Clin Res Ed) 323(7316):773–776

    Article  CAS  Google Scholar 

  64. Lassen K, Soop M, Nygren J, Cox PBW, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KCH, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CHC (2009) Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144(10):961–969

    Article  PubMed  Google Scholar 

  65. Baan AH, Vermeulen H, van der Meulen J, Bossuyt P, Olszyna D, Gouma DJ (2003) The effect of suprapubic catheterization versus transurethral catheterization after abdominal surgery on urinary tract infection: a randomized controlled trial. Dig Surg 20(4):290–295

    Article  PubMed  CAS  Google Scholar 

  66. Targarona EM, Balague C, Marin J, Neto RB, Martinez C, Garriga J, Trias M (2005) Energy sources for laparoscopic colectomy: a prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis. Surg Innov 12(4):339–344

    Article  PubMed  Google Scholar 

  67. Harold KL, Pollinger H, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc 17(8):1228–1230

    Article  PubMed  CAS  Google Scholar 

  68. Hübner M, Hahnloser D, Hetzer F, Müller MK, Clavien P-A, Demartines N (2007) A prospective randomized comparison of two instruments for dissection and vessel sealing in laparoscopic colorectal surgery. Surg Endosc 21(4):592–594

    Article  PubMed  Google Scholar 

  69. Campagnacci R, de Sanctis A, Baldarelli M, Rimini M, Lezoche G, Guerrieri M (2007) Electrothermal bipolar vessel sealing device vs. ultrasonic coagulating shears in laparoscopic colectomies: a comparative study. Surg Endosc 21(9):1526–1531

    Article  PubMed  Google Scholar 

  70. Morino M, Rimonda R, Allaix ME, Giraudo G, Garrone C (2005) Ultrasonic versus standard electric dissection in laparoscopic colorectal surgery: a prospective randomized clinical trial. Ann Surg 242(6):897–901 (discussion 901)

    Article  PubMed  Google Scholar 

  71. Zhou B-J, Song W-Q, Yan Q-H, Cai J-H, Wang F-A, Liu J, Zhang G-J, Duan G-Q, Zhang Z-X (2008) Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer. World J Gastroenterol 14(25):4065–4069

    Article  PubMed  Google Scholar 

  72. Heald RJ (1995) Total mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensus. Br J Surg 82(10):1297–1299

    Article  PubMed  CAS  Google Scholar 

  73. Nagtegaal ID, van de Velde CJH, van der Worp E, Kapiteijn E, Quirke P, van Krieken JHJM (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20(7):1729–1734

    Article  PubMed  Google Scholar 

  74. Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241(3):465–469

    Article  PubMed  Google Scholar 

  75. Poulin EC, Mamazza J, Schlachta CM, Grégoire R, Roy N (1999) Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma. Ann Surg 229(4):487–492

    Article  PubMed  CAS  Google Scholar 

  76. Leung KL, Kwok SP, Lau WY, Meng WC, Lam TY, Kwong KH, Chung CC, Li AK (1997) Laparoscopic-assisted resection of rectosigmoid carcinoma, Immediate and medium-term results. Arch Surg 132(7):761–764 (discussion 765)

    PubMed  CAS  Google Scholar 

  77. Bärlehner E, Decker T, Anders S, Heukrodt B (2001) Laparoscopic surgery of rectal carcinoma. Radical oncology and late results. Z Chirurgie 126(4):302–306

    Article  Google Scholar 

  78. Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237(3):335–342

    PubMed  Google Scholar 

  79. Delgado S, Momblán D, Salvador L, Bravo R, Castells A, Ibarzabal A, Piqué JM, Lacy AM (2004) Laparoscopic-assisted approach in rectal cancer patients: lessons learned from >200 patients. Surg Endosc 18(10):1457–1462

    Article  PubMed  CAS  Google Scholar 

  80. Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18(2):281–289

    Article  PubMed  CAS  Google Scholar 

  81. Zhou Z-G, Hu M, Li Y, Lei W-Z, Yu Y-Y, Cheng Z, Li L, Shu Y, Wang T-C (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18(8):1211–1215

    Article  PubMed  Google Scholar 

  82. Dulucq J-L, Wintringer P, Stabilini C, Mahajna A (2005) Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc 19(11):1468–1474

    Article  PubMed  Google Scholar 

  83. Bretagnol F, Lelong B, Laurent C, Moutardier V, Rullier A, Monges G, Delpero J-R, Rullier E (2005) The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 19(7):892–896

    Article  PubMed  CAS  Google Scholar 

  84. Morino M, Allaix ME, Giraudo G, Corno F, Garrone C (2005) Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 19(11):1460–1467

    Article  PubMed  CAS  Google Scholar 

  85. Veenhof AAFA, Engel AF, Craanen ME, Meijer S, de Lange-de Klerk ESM, van der Peet DL, Meijerink WJHJ, Cuesta MA (2007) Laparoscopic versus open total mesorectal excision: a comparative study on short-term outcomes. A single-institution experience regarding anterior resections and abdominoperineal resections. Dig Surg 24(5):367–374

    Article  PubMed  CAS  Google Scholar 

  86. Martinez C, Targarona EM, Balague C (2007) Laparoscopic surgery for treatmetn of rectal cancer. A single center 8 year experience. Surg Endosc 21:S190

    Google Scholar 

  87. Laurent C, Leblanc F, Gineste C, Saric J, Rullier E (2007) Laparoscopic approach in surgical treatment of rectal cancer. Br J Surg 94(12):1555–1561

    Article  PubMed  CAS  Google Scholar 

  88. Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96(9):982–989

    Article  PubMed  CAS  Google Scholar 

  89. Kuroyanagi H, Akiyoshi T, Oya M, Fujimoto Y, Ueno M, Yamaguchi T, Muto T (2009) Laparoscopic-assisted anterior resection with double-stapling technique anastomosis: safe and feasible for lower rectal cancer? Surg Endosc 23(10):2197–2202

    Article  PubMed  Google Scholar 

  90. Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N (2008) Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23(7):703–707

    Article  PubMed  Google Scholar 

  91. Peeters KCMJ, Tollenaar RAEM, Marijnen CAM, Klein Kranenbarg E, Steup WH, Wiggers T, Rutten HJ, van de Velde CJH (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92(2):211–216

    Article  PubMed  CAS  Google Scholar 

  92. Hüser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248(1):52–60

    Article  PubMed  Google Scholar 

  93. Veenhof AAFA, Engel AF, van der Peet DL, Sietses C, Meijerink WJHJ, de Lange-de Klerk ESM, Cuesta MA (2008) Technical difficulty grade score for the laparoscopic approach of rectal cancer: a single institution pilot study. Int J Colorectal Dis 23(5):469–475

    Article  PubMed  CAS  Google Scholar 

  94. Targarona EM, Balague C, Pernas JC, Martinez C, Berindoague R, Gich I, Trias M (2008) Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3-dimensional reconstruction of the pelvic anatomy. Ann Surg 247(4):642–649

    Article  PubMed  Google Scholar 

  95. Brannigan AE, De Buck S, Suetens P, Penninckx F, D□Hoore A (2006) Intracorporeal rectal stapling following laparoscopic total mesorectal excision: overcoming a challenge. Surg Endosc 20(6):952–955

    Article  PubMed  CAS  Google Scholar 

  96. Soop M, Nelson H (2008) Laparoscopic-assisted proctectomy for rectal cancer: on trial. Ann Surg Oncol 15(9):2357–2359

    Article  PubMed  Google Scholar 

  97. Buunen M, Bonjer HJ, Hop WCJ, Haglind E, Kurlberg G, Rosenberg J, Lacy AM, Cuesta MA, DH□oore A, Fürst A, Lange JF, Jess P, Bulut O, Poornoroozy P, Jensen KJ, Christensen MM, Lundhus E, Ovesen H, Birch D, Iesalnieks I, Jäger C, Kreis M, van Riet Y, van der Harst E, Gerhards MF, Bemelman WA, Hansson BME, Neijenhuis PA, Prins HA, Balague C, Targarona E, Luján Mompeán JA, Franco Osorio JD, Garcia Molina FJ, Skullman S, Läckberg Z, Kressner U, Matthiessen P, Kim SH, Poza AA (2009) COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer. Danish Med Bull 56(2):89–91

    PubMed  CAS  Google Scholar 

  98. Tjandra JJ, Chan MKY, Yeh CH (2008) Laparoscopic- vs. hand-assisted ultralow anterior resection: a prospective study. Dis Colon Rectum 51(1):26–31

    Article  PubMed  Google Scholar 

  99. Yamaguchi Y, Minami K, Kawabuchi Y, Emi M, Toge T (2005) Anterior resection of rectal cancer through a one hand-size incision with or without laparoscopy: proposal of one hand-size incision surgery (OHaSIS). J Surg Res 129(1):136–141

    Article  PubMed  Google Scholar 

  100. Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22(7):1601–1608

    Article  PubMed  CAS  Google Scholar 

  101. Choi DJ, Kim SH, Lee PJM, Kim J, Woo SU (2009) Single-stage totally robotic dissection for rectal cancer surgery: technique and short-term outcome in 50 consecutive patients. Dis Colon Rectum 52(11):1824–1830

    Article  PubMed  Google Scholar 

  102. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Biancafarina A, Casciola L (2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 13(2):176–183

    Google Scholar 

  103. Civello IM, Cavicchioni C, Tacchino RM, Matera D, Valentini V, Manfrida S, Greco F (2007) Laparoscopic resection with intraoperative radiotherapy: a new step in the multimodal treatment of advanced colorectal cancer. Surg Endosc 21(2):330–332

    Article  PubMed  CAS  Google Scholar 

  104. Vithiananthan S, Cooper Z, Betten K, Stapleton GS, Carter J, Huang EH, Whelan RL (2001) Hybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resection. Dis Colon Rectum 44(7):927–935

    Article  PubMed  CAS  Google Scholar 

  105. Ng K-H, Ng DC-K, Cheung HY-S, Wong JC-H, Yau KK-K, Chung CC-C, Li MK-W (2009) Laparoscopic resection for rectal cancers: lessons learned from 579 cases. Ann Surg 249(1):82–86

    Article  PubMed  Google Scholar 

  106. Bretagnol F, Rullier E, Couderc P, Rullier A, Saric J (2003) Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis 5(5):451–453

    Article  PubMed  CAS  Google Scholar 

  107. Fürst A, Suttner S, Agha A, Beham A, Jauch K-W (2003) Colonic J-pouch vs. coloplasty following resection of distal rectal cancer: early results of a prospective, randomized, pilot study. Dis Colon Rectum 46(9):1161–1166

    Article  PubMed  Google Scholar 

  108. Liang J-T, Lai H-S, Lee P-H, Huang K-C (2007) Comparison of functional and surgical outcomes of laparoscopic-assisted colonic J-pouch versus straight reconstruction after total mesorectal excision for lower rectal cancer. Ann Surg Oncol 14(7):1972–1979

    Article  PubMed  Google Scholar 

  109. Brown CJ, Fenech DS, McLeod RS (2008) Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev (Online) (2):CD006040

  110. Fazio VW, Zutshi M, Remzi FH, Parc Y, Ruppert R, Fürst A, Celebrezze J, Galanduik S, Orangio G, Hyman N, Bokey L, Tiret E, Kirchdorfer B, Medich D, Tietze M, Hull T, Hammel J (2007) A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 246(3):481–488 (discussion 488–490)

    Article  PubMed  Google Scholar 

  111. Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90(4):445–451

    Article  PubMed  CAS  Google Scholar 

  112. Pugliese R, Di Lernia S, Sansonna F, Scandroglio I, Maggioni D, Ferrari GC, Costanzi A, Magistro C, De Carli S (2008) Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases. Am J Surg 195(2):233–238

    Article  PubMed  Google Scholar 

  113. Targarona EM, Pons MJ, Anglada MT, Taurá P, Trias M (1993) Laparoscopic abdominoperineal resection of the rectum. Br J Surg 80(4):535

    Article  PubMed  CAS  Google Scholar 

  114. Larach SW, Salomon MC, Williamson PR, Goldstein E (1993) Laparoscopic assisted abdominoperineal resection. Surg Laparosc Endosc 3(2):115–118

    PubMed  CAS  Google Scholar 

  115. Darzi A, Lewis C, Menzies-Gow N, Guillou PJ, Monson JR (1995) Laparoscopic abdominoperineal excision of the rectum. Surg Endosc 9(4):414–417

    Article  PubMed  CAS  Google Scholar 

  116. Scheidbach H, Schneider C, Konradt J, Bärlehner E, Köhler L, Wittekind C, Köckerling F (2002) Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc 16(1):7–13

    Article  PubMed  CAS  Google Scholar 

  117. Baker RP, White EE, Titu L, Duthie GS, Lee PWR, Monson JRT (2002) Does laparoscopic abdominoperineal resection of the rectum compromise long-term survival? Dis Colon Rectum 45(11):1481–1485

    Article  PubMed  Google Scholar 

  118. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726

    Google Scholar 

  119. Koerner K, Datena S, Erwin L (1997) Laparoscopic-assisted abdominoperineal resection in the prone position. An alternative technique. Surg Endosc 11(6):684–686

    Article  PubMed  CAS  Google Scholar 

  120. West NP, Anderin C, Smith KJE, Holm T, Quirke P (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97(4):588–599

    Article  PubMed  CAS  Google Scholar 

  121. Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94(2):232–238

    Article  PubMed  CAS  Google Scholar 

  122. Biondo S, Ortiz H, Lujan J, Codina-Cazador A, Espin E, Garcia-Granero E, Kreisler E, de Miguel M, Alos R, Echeverria A (2010) Quality of mesorectum after laparoscopic resection for rectal cancer—results of an audited teaching programme in Spain. Colorectal Dis 12(1):24–31

    Article  PubMed  CAS  Google Scholar 

  123. Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250(1):54–61

    Article  PubMed  Google Scholar 

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

  125. Varela JE, Wilson SE, Nguyen NT (2010) Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc 24(2):270–276

    Article  PubMed  Google Scholar 

  126. Dobson MW, Geisler D, Fazio V, Remzi F, Hull T, Vogel J (2011) Minimally invasive surgical wound infections: laparoscopic surgery decreases morbidity of surgical site infections and decreases the cost of wound care. Colorectal Dis 13(7):811–815

    Google Scholar 

  127. Gujral S, Avery KNL, Blazeby JM (2008) Quality of life after surgery for colorectal cancer: clinical implications of results from randomised trials. Support Care Cancer 16(2):127–132

    Article  PubMed  Google Scholar 

  128. Fujii S, Ota M, Ichikawa Y, Yamagishi S, Watanabe K, Tatsumi K, Watanabe J, Suwa H, Oshima T, Kunisaki C, Ohki S, Endo I, Shimada H (2010) Comparison of short, long-term surgical outcomes and mid-term health-related quality of life after laparoscopic and open resection for colorectal cancer: a case-matched control study. Int J Colorectal Dis 25(11):1311–1323

    Article  PubMed  Google Scholar 

  129. Scarpa M, Erroi F, Ruffolo C, Mollica E, Polese L, Pozza G, Norberto L, D’Amico DF, Angriman I (2009) Minimally invasive surgery for colorectal cancer: quality of life, body image, cosmesis, and functional results. Surg Endosc 23(3):577–582

    Article  PubMed  Google Scholar 

  130. Park J-S, Kang S-B, Kim S-W, Cheon G-N (2007) Economics and the laparoscopic surgery learning curve: comparison with open surgery for rectosigmoid cancer. World J Surg 31(9):1827–1834

    Article  PubMed  Google Scholar 

  131. Franks PJ, Bosanquet N, Thorpe H, Brown JM, Copeland J, Smith AMH, Quirke P, Guillou PJ (2006) Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Br J Cancer 95(1):6–12

    Article  PubMed  CAS  Google Scholar 

  132. Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50(4):464–471

    Article  PubMed  Google Scholar 

  133. Dowson HM, Huang A, Soon Y, Gage H, Lovell DP, Rockall TA (2007) Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum 50(6):908–919

    Article  PubMed  Google Scholar 

  134. De Verteuil RM, Hernández RA, Vale L (2007) Economic evaluation of laparoscopic surgery for colorectal cancer. Int J Technol Assess Health Care 23(4):464–472

    PubMed  Google Scholar 

  135. Arteaga González I, Díaz Luis H, Martín Malagón A, López-Tomassetti Fernández EM, Arranz Duran J, Carrillo Pallares A (2006) A comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curve. Int J Colorectal Dis 21(6):590–595

    Article  PubMed  Google Scholar 

  136. Sengupta S, Tjandra JJ (2001) Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 44(9):1345–1361

    Article  PubMed  CAS  Google Scholar 

  137. Nastro P, Beral D, Hartley J, Monson JR (2005) Local excision of rectal cancer: review of literature. Dig Surg 22(1–2):6–15

    Google Scholar 

  138. Perretta S (2006) Surgical treatment of rectal cancer: local resection. Surg Oncol Clin N Am 15(1):67–93

    Article  PubMed  Google Scholar 

  139. Buess G, Hutterer F, Theiss J, Böbel M, Isselhard W, Pichlmaier H (1984) [A system for a transanal endoscopic rectum operation]. Der Chirurg; Z Gebiete der operativen Medizen 55(10):677–680

    CAS  Google Scholar 

  140. Buess G, Kipfmüller K, Hack D, Grüssner R, Heintz A, Junginger T (1988) Technique of transanal endoscopic microsurgery. Surg Endosc 2(2):71–75

    Article  PubMed  CAS  Google Scholar 

  141. Bretagnol F, Merrie A, George B, Warren BF, Mortensen NJ (2007) Local excision of rectal tumours by transanal endoscopic microsurgery. Br J Surg 94(5):627–633

    Article  PubMed  CAS  Google Scholar 

  142. Ganai S, Kanumuri P, Rao RS, Alexander AI (2006) Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers. Ann Surg Oncol 13(4):547–556

    Article  PubMed  Google Scholar 

  143. Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48(2):270–284

    Article  PubMed  Google Scholar 

  144. Christoforidis D, Cho H-M, Dixon MR, Mellgren AF, Madoff RD, Finne CO (2009) Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 249(5):776–782

    Article  PubMed  Google Scholar 

  145. Neugebauer EAM, Becker M, Buess GF, Cuschieri A, Dauben H-P, Fingerhut A, Fuchs KH, Habermalz B, Lantsberg L, Morino M, Reiter-Theil S, Soskuty G, Wayand W, Welsch T (2010) EAES recommendations on methodology of innovation management in endoscopic surgery. Surg Endosc 24(7):1594–1615

    Article  PubMed  Google Scholar 

  146. Flora ED, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ (2008) A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery: experimental models, techniques, and applicability to the clinical setting. Ann Surg 247(4):583–602

    Article  PubMed  Google Scholar 

  147. Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210

    Article  PubMed  Google Scholar 

  148. Kang S-B, Park JW, Jeong S-Y, Nam BH, Choi HS, Kim D-W, Lim S-B, Lee T-G, Kim DY, Kim J-S, Chang HJ, Lee H-S, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim D-H, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645

    Article  PubMed  Google Scholar 

  149. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645

    Article  PubMed  CAS  Google Scholar 

  150. COLOR II: Laparoscopic Versus Open Rectal Cancer Removal—Full Text View—ClinicalTrials.gov [Internet]. http://clinicaltrials.gov/ct2/show/NCT00297791?term=rectal+cancer+AND+surgery+AND+COLOR&rank=1. Cited 1 Mar 2011

  151. Quah HM, Jayne DG, Eu KW, Seow-Choen F (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89(12):1551–1556

    Article  PubMed  CAS  Google Scholar 

  152. Anthuber M, Fuerst A, Elser F, Berger R, Jauch K-W (2003) Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 46(8):1047–1053

    Article  PubMed  Google Scholar 

  153. Tsang WWC, Chung CC, Kwok SY, Li MKW (2006) Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results. Ann Surg 243(3):353–358

    Article  PubMed  CAS  Google Scholar 

  154. Agha A, Fürst A, Hierl J, Iesalnieks I, Glockzin G, Anthuber M, Jauch K-W, Schlitt HJ (2008) Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients. Surg Endosc 22(10):2229–2237

    Article  PubMed  Google Scholar 

  155. Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ (2005) Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg 92(9):1124–1132

    Article  PubMed  CAS  Google Scholar 

  156. Liang J-T, Lai H-S, Lee P-H (2007) Laparoscopic pelvic autonomic nerve-preserving surgery for patients with lower rectal cancer after chemoradiation therapy. Ann Surg Oncol 14(4):1285–1287

    Article  PubMed  Google Scholar 

  157. Breukink SO, van Driel MF, Pierie JPEN, Dobbins C, Wiggers T, Meijerink WJHJ (2008) Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision. Int J Colorectal Dis 23(12):1199–1205

    Article  PubMed  CAS  Google Scholar 

  158. Asoglu O, Matlim T, Karanlik H, Atar M, Muslumanoglu M, Kapran Y, Igci A, Ozmen V, Kecer M, Parlak M (2009) Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc 23(2):296–303

    Article  PubMed  Google Scholar 

  159. Morino M, Parini U, Allaix ME, Monasterolo G, Brachet Contul R, Garrone C (2009) Male sexual and urinary function after laparoscopic total mesorectal excision. Surg Endosc 23(6):1233–1240

    Article  PubMed  Google Scholar 

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Acknowledgements

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

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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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Siegel, R., Cuesta, M.A., Targarona, E. et al. Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 25, 2423–2440 (2011). https://doi.org/10.1007/s00464-011-1805-z

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