Skip to main content

Advertisement

SpringerLink
Log in

Update on Minimally Invasive Surgical Approaches for Rectal Cancer

  • Gastrointestinal Cancers (J Meyer, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review aims to clarify the current role of minimally invasive surgery in the treatment of rectal cancer, highlighting short- and long-term outcomes from the latest trials and studies.

Recent Findings

Data from previous trials has been conflicting, with some failing to demonstrate non-inferiority of laparoscopic surgical resection of rectal cancer compared to an open approach and others demonstrating similar clinical outcomes. Robot-assisted surgery was thought to be a promising solution to the challenges faced by laparoscopic surgery, and even though the only randomized controlled trial to date comparing these two techniques did not show superiority of robot-assisted surgery over laparoscopy, more recent retrospective data suggests a statistically significant higher negative circumferential resection margin rate, decreased frequency of conversion to open, and less sexual and urinary complications.

Summary

Minimally invasive surgery techniques for resection of rectal cancer, particularly robot-assisted, offer clear short-term peri-operative benefits over an open approach; however, current data has yet to display non-inferiority in terms of oncological outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30. https://doi.org/10.3322/caac.21442.

    Article  PubMed  Google Scholar 

  2. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100:75–82. https://doi.org/10.1002/bjs.8945.

    Article  CAS  PubMed  Google Scholar 

  3. Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15:767–74. https://doi.org/10.1016/S1470-2045(14)70205-0.

    Article  PubMed  Google Scholar 

  4. van der Pas MHGM, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WCJ, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–8. https://doi.org/10.1016/S1470-2045(13)70016-0.

    Article  PubMed  Google Scholar 

  5. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes the ACOSOG Z6051 randomized clinical trial. JAMA - J Am Med Assoc. 2015;314:1346–55. https://doi.org/10.1001/jama.2015.10529.

    Article  CAS  Google Scholar 

  6. Stevenson ARL, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA - J Am Med Assoc. 2015;314:1356–63. https://doi.org/10.1001/jama.2015.12009.

    Article  CAS  Google Scholar 

  7. Weber PA, Merola S, Wasielewski A, Ballantyne GH, Delaney CP. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. 2002;45:1689–96. https://doi.org/10.1007/s10350-004-7261-2.

    Article  PubMed  Google Scholar 

  8. Hashizume M, Shimada M, Tomikawa M, Ikeda Y, Takahashi I, Abe R, et al. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc Other Interv Tech. 2002;16:1187–91. https://doi.org/10.1007/s004640080154.

    Article  CAS  Google Scholar 

  9. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer the rolarr randomized clinical trial. JAMA - J Am Med Assoc. 2017;318:1569–80. https://doi.org/10.1001/jama.2017.7219.

    Article  Google Scholar 

  10. Liao G, Zhao Z, Lin S, Li R, Yuan Y, Du S, et al. Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials. World J Surg Oncol. 2014;12:122. https://doi.org/10.1186/1477-7819-12-122.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Li MZ, Bin XL, Wu WH, Bin YS, Li SZ. Meta-analysis of laparoscopic versus open colorectal surgery within fast-track perioperative care. Dis Colon Rectum. 2012. https://doi.org/10.1097/DCR.0b013e31824bd31e.

  12. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26. https://doi.org/10.1016/S0140-6736(05)66545-2.

    Article  PubMed  Google Scholar 

  13. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH. A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol. 2012;19:2485–93. https://doi.org/10.1245/s10434-012-2262-1.

    Article  PubMed  Google Scholar 

  14. Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP, Yun SH. Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison. World J Surg. 2014;38:1834–42. https://doi.org/10.1007/s00268-013-2419-5.

    Article  PubMed  Google Scholar 

  15. Lee GC, Bordeianou LG, Francone TD, Blaszkowsky LS, Goldstone RN, Ricciardi R, et al. Superior pathologic and clinical outcomes after minimally invasive rectal cancer resection, compared to open resection. Surg Endosc. 2020;34:3435–48. https://doi.org/10.1007/s00464-019-07120-2.

    Article  PubMed  Google Scholar 

  16. Simillis C, Lal N, Thoukididou SN, Kontovounisios C, Smith JJ, Hompes R, et al. Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg. 2019;270:59–68. https://doi.org/10.1097/SLA.0000000000003227.

    Article  PubMed  Google Scholar 

  17. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MHGM, de Lange-de Klerk ESM, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372:1324–32. https://doi.org/10.1056/nejmoa1414882.

    Article  CAS  PubMed  Google Scholar 

  18. Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage ii to iii rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg. 2019;269:589–95. https://doi.org/10.1097/SLA.0000000000003002.

    Article  PubMed  Google Scholar 

  19. Skancke M, Schoolfield C, Umapathi B, Amdur R, Brody F, Obias V. Minimally Invasive surgery for rectal adenocarcinoma shows promising outcomes compared to laparotomy, a National Cancer Database observational analysis. J Laparoendosc Adv Surg Tech. 2019;29:218–24. https://doi.org/10.1089/lap.2018.0471.

    Article  Google Scholar 

  20. Kim NK, Aahn TW, Park JK, Lee KY, Lee WH, Sohn SK, et al. Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum. 2002;45:1178–85. https://doi.org/10.1007/s10350-004-6388-5.

    Article  PubMed  Google Scholar 

  21. Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg. 2005;92:1124–32. https://doi.org/10.1002/bjs.4989.

    Article  CAS  PubMed  Google Scholar 

  22. Luca F, Valvo M, Ghezzi TL, Zuccaro M, Cenciarelli S, Trovato C, et al. Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg. 2013;257:672–8. https://doi.org/10.1097/SLA.0b013e318269d03b.

    Article  PubMed  Google Scholar 

  23. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004. doi:https://doi.org/10.1056/nejmoa032651.

  24. Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD. SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc. 2013;27:1–10. https://doi.org/10.1007/s00464-012-2592-x.

    Article  PubMed  Google Scholar 

  25. Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Multidimensional analysis of the learning curve for laparoscopic colorectal surgery: lessons from 1,000 cases of laparoscopic colorectal surgery. Surg Endosc Other Interv Tech. 2009;23:839–46. https://doi.org/10.1007/s00464-008-0259-4.

    Article  Google Scholar 

  26. Li JCM, Hon SSF, Ng SSM, Lee JFY, Yiu RYC, Leung KL. The learning curve for laparoscopic colectomy: experience of a surgical fellow in an university colorectal unit. Surg Endosc. 2009;23:1603–8. https://doi.org/10.1007/s00464-009-0497-0.

    Article  PubMed  Google Scholar 

  27. Akiyoshi T, Kuroyanagi H, Ueno M, Oya M, Fujimoto Y, Konishi T, et al. Learning curve for standardized laparoscopic surgery for colorectal cancer under supervision: a single-center experience. Surg Endosc. 2011;25:1409–14. https://doi.org/10.1007/s00464-010-1404-4.

    Article  PubMed  Google Scholar 

  28. Son GM, Kim JG, Lee JC, Suh YJ, Cho HM, Lee YS, et al. Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech. 2010;20:609–17. https://doi.org/10.1089/lap.2010.0007.

    Article  Google Scholar 

  29. Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg. 2009;13:275–81. https://doi.org/10.1007/s11605-008-0722-5.

    Article  PubMed  Google Scholar 

  30. Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N. Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc. 2011;25:2972–9. https://doi.org/10.1007/s00464-011-1655-8.

    Article  PubMed  Google Scholar 

  31. Jonker FHW, Hagemans JAW, Verhoef C, Burger JWA. The impact of hospital volume on perioperative outcomes of rectal cancer. Eur J Surg Oncol. 2017;43:1894–900. https://doi.org/10.1016/j.ejso.2017.07.009.

    Article  CAS  PubMed  Google Scholar 

  32. Yamaguchi T, Kinugasa Y, Shiomi A, Sato S, Yamakawa Y, Kagawa H, et al. Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc. 2015;29:1679–85. https://doi.org/10.1007/s00464-014-3855-5.

    Article  PubMed  Google Scholar 

  33. Aghayeva A, Baca B. Robotic sphincter saving rectal cancer surgery: a learning curve analysis. Int J Med Robot Comput Assist Surg. 2020;16:e2112. https://doi.org/10.1002/rcs.2112.

    Article  Google Scholar 

  34. Foo CC, Law WL. The learning curve of robotic-assisted low rectal resection of a novice rectal surgeon. World J Surg. 2016;40:456–62. https://doi.org/10.1007/s00268-015-3251-x.

    Article  PubMed  Google Scholar 

  35. Kim YW, Lee HM, Kim NK, Min BS, Lee KY. The learning curve for robot-assisted total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutaneous Tech. 2012;22:400–5. https://doi.org/10.1097/SLE.0b013e3182622c2d.

    Article  Google Scholar 

  36. Bolger JC, Broe MP, Zarog MA, Looney A, McKevitt K, Walsh D, et al. Initial experience with a dual-console robotic-assisted platform for training in colorectal surgery. Tech Coloproctol. 2017;21:721–7. https://doi.org/10.1007/s10151-017-1687-8.

    Article  CAS  PubMed  Google Scholar 

  37. Ramji KM, Cleghorn MC, Josse JM, MacNeill A, O’Brien C, Urbach D, et al. Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center. Surg Endosc. 2016;30:1337–43. https://doi.org/10.1007/s00464-015-4390-8.

    Article  PubMed  Google Scholar 

  38. Keller DS, Senagore AJ, Lawrence JK, Champagne BJ, Delaney CP. Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc. 2014;28:212–21. https://doi.org/10.1007/s00464-013-3163-5.

    Article  PubMed  Google Scholar 

  39. Silva-Velazco J, Dietz DW, Stocchi L, Costedio M, Gorgun E, Kalady MF, et al. Considering value in rectal cancer surgery: an analysis of costs and outcomes based on the open, laparoscopic, and robotic approach for proctectomy. Ann Surg. 2017;265:960–8. https://doi.org/10.1097/SLA.0000000000001815.

    Article  PubMed  Google Scholar 

  40. Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP. Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg. 2012;99:1219–26. https://doi.org/10.1002/bjs.8841.

    Article  CAS  PubMed  Google Scholar 

  41. Justiniano CF, Becerra AZ, Xu Z, Aquina CT, Boodry CI, Schymura MJ, et al. A population-based study of 90-day hospital cost and utilization associated with robotic surgery in colon and rectal cancer. J Surg Res. 2020;245:136–44. https://doi.org/10.1016/j.jss.2019.07.052.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock, Baltimore, MD, 656, USA

    Leonardo E Garcia, James Taylor & Chady Atallah

Authors
  1. Leonardo E Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chady Atallah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Leonardo E. Garcia: literature review, drafting article; James Taylor: literature review, revision of article; Chady Atallah: critical revision of the article, approval of article

Corresponding author

Correspondence to Chady Atallah.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Gastrointestinal Cancers

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garcia, L.E., Taylor, J. & Atallah, C. Update on Minimally Invasive Surgical Approaches for Rectal Cancer. Curr Oncol Rep 23, 117 (2021). https://doi.org/10.1007/s11912-021-01110-1

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11912-021-01110-1

Keywords

Search

Navigation