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Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3587–3595 | Cite as

Controversies in Surgical Oncology: Does the Minimally Invasive Approach for Rectal Cancer Provide Equivalent Oncologic Outcomes Compared with the Open Approach?

  • Robert K. Cleary
  • Arden M. Morris
  • George J. Chang
  • Amy L. Halverson
Colorectal Cancer

Abstract

Background

Compared with open surgery, minimally invasive surgery for colon cancer has been shown to improve short-term outcomes and yield equivalent long-term oncologic results. It remains to be seen if oncologic outcomes for the minimally invasive approach for rectal cancer are equivalent to traditional open rectal resection.

Methods

We conducted a systematic review of Medline, SCOPUS, and Cochrane databases. Relevant studies were selected using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five key questions comparing minimally invasive and open oncologic outcomes for rectal cancer were specifically analyzed. A meta-analysis was not done due to heterogeneity of studies.

Results

Forty-five studies met inclusion criteria, including six randomized controlled trials. The laparoscopic approach to rectal resection was not more likely than the traditional open approach to have clear circumferential and distal margins, a complete total mesorectal excision grade, ≥ 12 lymph nodes in the resected specimen, reduced local recurrence rates, or reduced overall survival rates. Two randomized trials revealed that successful laparoscopic resection was not noninferior to open.

Conclusions

Caution should be exercised when choosing surgical options for rectal cancer. Results of randomized trials could not prove that short-term oncologic outcomes of laparoscopic surgery were equivalent to those after open surgery even when performed by surgeons with laparoscopic expertise. However, reported long-term data have not shown a difference in outcomes between laparoscopic and open surgery. Future advances in minimally invasive technology may improve oncologic margins but these will require careful study and scrutiny.

Notes

Funding Information

No grant support or other funds were received for this work.

Disclosures

Dr. Cleary has received honoraria from Intuitive Surgical, Inc. for educational speaking. He has received research funding from Blue Cross Blue Shield of Michigan. Dr. Morris has no conflict of interest to disclose. Dr. Chang is a consultant to Johnson and Johnson and MORE Health. He has received research funding from Agendia. Dr. Halverson has no conflict of interest to disclose.

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Division of Colon and Rectal SurgerySt Joseph Mercy Hospital Ann ArborAnn ArborUSA
  2. 2.Section of Colon and Rectal SurgeryStanford University Medical CenterStanfordUSA
  3. 3.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Division of Colon and Rectal SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA

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