Abstract
The curative treatment of locally advanced rectal cancer is currently based on chemoradiotherapy
and total mesorectal excision (TME). Laparoscopy has developed considerably because
of obvious clinical benefits such as reduced pain and shorter hospital stay. Recently,
several prospective randomized clinical trials with long-term follow-up have showed
that laparoscopy is noninferior to laparotomy with the same oncologic outcomes in
terms of survival and local control rate. However, laparoscopic TME remains a challenging
procedure requiring a high level of expertise and a long learning curve to ensure
an adequate and safe resection. The only relative contraindication of laparoscopic
rectal surgery is T4 rectal cancer extended beyond the plane of TME. In this situation,
it is reasonable to consider an open resection to avoid an uncomplete resection. In
obese and elderly patients, laparoscopic TME also provides the same benefits as in
nonobese and younger patients but may be more difficult to achieve. This review summarizes
current knowledge on the place of laparoscopic TME in the treatment of rectal cancer.
Keywords
rectal cancer - TME surgery - laparoscopy
