Current Applications of Laparoscopic Surgery in the Treatment of Rectal Cancer

ABSTRACT

Laparoscopic surgical techniques still have not been adopted as a standard treatment for rectal cancer. Since having been first described, important steps have been undertaken to demonstrate oncologic principles including high vascular ligation, total mesorectal excision, and the preservation of the pelvic autonomic nerves. Most evidence regarding outcomes is based on small-scale retrospective or nonrandomized prospective studies. Recent data regarding the port-site recurrence are lower than initially reported and data regarding the long-term oncologic outcome have not shown disadvantages. We believe the proven short-term benefits of laparoscopic colon surgery are also applicable to laparoscopic rectal cancer surgery. In addition, this technique has the potential to allow a better oncologic resection with a better short-term functional outcome. This article will focus on current published experience and will also briefly describe the authors' technique and personal experience with this procedure.

KEYWORD

Rectal neoplasms - surgical procedures - laparoscopy - total mesorectal excision

REFERENCES

• 1 Leung K L, Yiu R Y, Lai P B, Lee J F, Thung K H, Lau W Y. Laparoscopic-assisted resection of colorectal carcinoma: five-year audit.  Dis Colon Rectum . 1999;  42 327-332
• 2 Milsom J W, Bohm B, Hammerhofer K. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report.  J Am Coll Surg . 1998;  187 46-54
• 3 Bruch H P, Schiedeck T H, Schwandner O. Laparoscopic colorectal surgery: a five-year experience.  Dig Surg . 1999;  16 45-54
• 4 Leung K L, Kwok S P, Lau W Y. Laparoscopic-assisted abdominoperineal resection for low rectal adenocarcinoma.  Surg Endosc . 2000;  14 67-70
• 5 Fleshman J W, Wexner S D, Anvari M. Laparoscopic versus open abdominoperineal resection for cancer.  Dis Colon Rectum . 1999;  42 930-939
• 6 Leung K L, Kwok S P, Lau W Y. Laparoscopic-assisted resection of rectosigmoid carcinoma. Immediate and medium-term results.  Arch Surg . 1997;  132 761-764
• 7 Tate J J, Kwok S, Dawson J W. Prospective comparison of laparoscopic and conventional anterior resection.  Br J Surg . 1993;  80 1396-1398
• 8 Kockerling F, Gastinger I, Schneider B. Laparoscopic abdominoperineal excision of the rectum with high ligation of the inferior mesenteric artery in the management of rectal carcinoma.  Endosc Surg Allied Technol . 1993;  1 16-19
• 9 Kockerling F, Gastinger I, Schneider B. Laparoscopic abdomino-perineal resection of the rectum with high intersection of the inferior mesenteric artery.  Chirurg . 1992;  63 345-348
• 10 Franklin Jr E M, Rosenthal D, Norem R F. Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma. A multicenter study.  Surg Endosc . 1995;  9 811-816
• 11 Lacy A M, Garcia-Valdecasas J C, Pique J M. Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer.  Surg Endosc . 1995;  9 1101-1105
• 12 MacFarlane J K, Ryall R D, Heald R J. Mesorectal excision for rectal cancer.  Lancet . 1993;  341 457-460
• 13 Milsom J W, Bohm B, Decanini C, Fazio V W. Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model.  Surg Endosc . 1994;  8 1117-1123
• 14 Franklin Jr E M, Rosenthal D, Abrego-Medina D. Prospective comparison of open versus laparoscopic colon surgery for carcinoma. Five-year results.  Dis Colon Rectum . 1996;  39 S35-S46
• 15 Hartley J E, Mehigan B J, Qureshi A E. Total mesorectal excision: assessment of the laparoscopic approach.  Dis Colon Rectum . 2001;  44 315-321
• 16 Decanini C, Milsom J W, Bohm B, Fazio V W. Laparoscopic oncologic abdominoperineal resection.  Dis Colon Rectum . 1994;  37 552-558
• 17 Bohm B, Milsom J W, Kitago K. Use of laparoscopic techniques in oncologic right colectomy in a canine model.  Ann Surg Oncol . 1995;  2 6-13
• 18 Weiser M R, Milsom J W. Laparoscopic total mesorectal excision with autonomic nerve preservation.  Semin Surg Oncol . 2000;  19 396-403
• 19 Milsom J W, Jerby B L, Kessler H. Prospective, blinded comparison of laparoscopic ultrasonography versus contrast-enhanced computerized tomography for liver assessment in patients undergoing colorectal carcinoma surgery.  Dis Colon Rectum . 2000;  43 44-49
• 20 Leung K L, Lai P B, Ho R L. Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial.  Ann Surg . 2000;  231 506-511
• 21 Fleshman J W, Nelson H, Peters W R. Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group.  Dis Colon Rectum . 1996;  39 S53-S58
• 22 Ramos J R, Petrosemolo R H, Valory E A. Abdominoperineal resection: laparoscopic versus conventional.  Surg Laparosc Endosc . 1997;  7 148-152
• 23 Wu J S, Birnbaum E H, Fleshman J W. Early experience with laparoscopic abdominoperineal resection.  Surg Endosc . 1997;  11 449-455
• 24 Schiedeck T H, Schwandner O, Baca I. Laparoscopic surgery for the cure of colorectal cancer: results of a German five-center study.  Dis Colon Rectum . 2000;  43 1-8