Minimally invasive approach to colorectal cancer: an evidence-based analysis

Minimally invasive surgery (MIS) was initially used for the treatment of colorectal benign disease. However, the indications for MIS techniques have progressively been expanded to include cancers. Nowadays, the indications for MIS are almost the same as those for open surgery. The scientific validation of MIS for colorectal cancer has favorably evolved. The advantages awaited for the short-term outcome were confirmed, although at the cost of longer operating time and higher costs. In parallel, tangible evidence of oncologic safety was demonstrated, and long-term results of MIS have been found comparable to those of open surgery. In the current state of MIS short-term superiority and log-term equality, less surgical injury, lower immune function depression and better postoperative outcome make MIS particularly suitable for delicate and difficult patients, such as elderly or obese; on the contrary, the lower costs have led to still consider open surgery as a valid alternative for low-impact resections (such as right colectomy). The continuous development in the field of MIS has recently led to the introduction of the single-port (SILS) and natural-orifice (NOTES) techniques, which allow better esthetic results, even if the their validation has not yet reached scientific evidence.