Laparoscopic approaches to rectal cancer

Laparoscopic colectomy has been proven oncologically equivalent to conventional surgery and is now generally agreed to offer patients a reduced length of stay, shorter recovery times, and improved cosmesis. In contrast, acceptance of laparoscopic proctectomy for rectal cancer has been much delayed and the enthusiasm of early studies has met considerable skepticism. For rectal cancer, it has been demonstrated that there is considerable variation between surgeons in disease-free survival and local pelvic recurrence after open proctectomy for rectal cancer. These differences are likely to be magnified when the technical challenge of laparoscopy is added to proctectomy. Minimally invasive approaches to rectal cancer need to demonstrate equivalent oncologic outcomes and maintenance or improvement in quality of life. This review will outline the current evidence for laparoscopy as a treatment option for patients with rectal cancer, emphasize the need for standardized approaches among multidisciplinary teams, and highlight the technical details of different laparoscopic operations for rectal cancer.