Minimally invasive surgery for rectal cancer

Minimally invasive surgical treatments for colon cancers have revolutionized surgical approaches and have been implemented broadly over the last two decades. On the other hand, robotic-assisted versus laparoscopic resections for rectal cancer and comparison of these minimally invasive approaches with the traditional open operation are controversial and challenging topics to discuss between the different surgical investigators. Recent published studies have shown somewhat differing data and results from randomized controlled and non-randomized trials comparing laparoscopic with open rectal resections as well as robotic-assisted with both open and laparoscopic approaches. The surgical approach for rectal cancer is a fascinating subject since there are several different endpoints which have been used to measure quality and outcome. Overall survival, disease free survival, and quality of life (QOL) are the most relevant endpoints of rectal cancer treatment. Among minimally invasive approaches, the robotic approach seems to be less invasive than conventional laparoscopic surgery (LS) and less than hand assisted approach due partly to the less traumatic intra-abdominal handling of tissues. A convincing clinical benefit of minimally invasive rectal cancer approaches could be due to diminished surgical stress response leading to reduced morbidity. For this review, we have performed a systematic review of rectal cancer surgical management focusing on minimally invasive approaches, focusing specifically on the latest results of randomized trials for robotic assisted and laparoscopic rectal cancer resection.