Laparoscopic Resection for Rectal Cancer: What Is the Evidence?

Abstract

Laparoscopic colectomy for colon cancer is a well-established procedure supported by several well-conducted large-scale randomised controlled trials. Patients could now be conferred the benefits of the minimally invasive approach while retaining comparable oncologic outcomes to the open approach. However, the benefits of laparoscopic proctectomy for rectal cancer remained controversial. While the laparoscopic approach is more technically demanding, results from randomised controlled trials regarding long term oncologic outcomes are only beginning to be reported. The impacts of bladder and sexual functions following proctectomy are considerable and are important contributing factors to the patients' quality of life in the long-term. These issues present a delicate dilemma to the surgeon in his choice of operative approach in tackling rectal cancer. This is compounded further by the rapid proliferation of various laparoscopic techniques including the hand assisted, robotic assisted, and single port laparoscopy. This review article aims to draw on the significant studies which have been conducted to highlight the short- and long-term outcomes and evidence for laparoscopic resection for rectal cancer.

Hand-assisted laparoscopic surgery versus conventional open surgery in intraoperative and postoperative outcomes for colorectal cancer

“…In line with previous review and mate-analysis, [ 6 , 19 ] there was no difference in lymph node harvested. We explained it that both HALS and OS need follow the principles of oncologic surgery.…”

“…[ 39 – 41 ] In our meta-analysis including 15 studies with 1962 patients, HALS group revealed a significantly less blood loss and smaller incision length, which are in line with the previous meta-analysis and reviews. [ 6 , 16 , 19 ] This demonstrated that HALS can improve cosmesis for patients compared with OS.…”

“…This result is supported by some other reviews. [ 6 , 16 ] Ding et al thought that the operative time of HALS was related with technique skills and case accumulation. [ 19 ] However, we hold the opinion that HALS was belong to minimally invasive technique though it had part feature of OS.…”

A meta-analysis of laparoscopic surgery versus conventional open surgery in the treatment of colorectal cancer

“…Currently, surgery remain the best treatment for colorectal cancer, which includes conventional laparoscopic surgery, hand-assisted laparoscopic surgery, robotic surgery, single-pore laparoscopic surgery, and open surgery. [3,4]…”

Urinary and sexual dysfunction rates and risk factors following rectal cancer surgery

“…Rectum cancer has been observed as the fourth frequent cancer among men and the second frequent cancer among women in our country [2]. Currently, the first step treatment in rectal cancer is surgery [3]. Rectal cancer surgery has advanced significantly in the recent years.…”