[Laparoscopic surgery for rectal cancer]

Although laparoscopic colon cancer surgery is widely accepted as a feasible alternative to open surgery, there is still limited evidence on the use of the laparoscopic approach for rectal cancer. Although laparoscopic rectal surgery is a technically demanding procedure with a steep learning curve because of adherence to the oncologic principle of total mesorectal excision, the laparoscopic approach has some advantages over open surgery, including not only less invasiveness but also a good surgical view of the deep pelvis through its magnification effect. At this time, information is still lacking on the long-term outcomes and efficicacy of laparoscopic rectal cancer surgery based on large-scale, randomized, controlled trials, and many clinical guidelines recommend that laparoscopic rectal cancer surgery should only be performed with expertise under a clinical trial setting. Nationwide surveys show the numbers of laparoscopic rectal cancer surgery cases are increasing in Japan, and about 20% of rectal cancer operations are performed laparoscopically, but concerns about the concurrently increasing anastomotic leakage rate should be noted. The development of laparoscopic instruments specifically to facilitate dissection and transection of the rectum in the deep pelvis is expected to increase the future widespread adoption of this procedure.