An update on laparoscopic resection for rectal cancer.

BACKGROUND In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as oncologically equivalent to conventional open surgery. The advantages of laparoscopic surgery have translated into smaller incisions and shorter recovery. However, the narrow confines of the bony pelvis and angling limits in current stapling technology, along with the standard practice of autonomic nerve-sparing total mesorectal excision, have made laparoscopic surgery in the setting of rectal cancer more challenging. The available literature focusing on laparoscopic resection for rectal cancer has been predominantly retrospective in nature, with a limited number of prospective studies. METHODS This article discusses the current status of laparoscopic rectal cancer resection. A review of the more recent retrospective and prospective data specifically on laparoscopic resection for mid to low rectal cancer was performed. RESULTS The number of prospective randomized trials addressing laparoscopic rectal cancer resection is limited. In the largest trial (MRC CLASICC), an initial increased rate of positive circumferential margins within the laparoscopic anterior resection cohort, although nonsignificant, raised concerns regarding its oncologic adequacy. These concerns did not translate into a difference in local recurrence at 3 years. Improved short-term outcomes, including quicker recovery times, shorter hospital stays, and reduced analgesic requirements (albeit at the price of longer operative times and higher overall cost), have been demonstrated in some studies. CONCLUSIONS In view of the limited prospective data, laparoscopic resection for mid to low rectal cancer is still investigational in the United States. While feasibility studies are promising, open surgical resection remains the current standard of care. It is hoped that the long-term results of ongoing and newly initiated multi-institutional trials will fully define the role of laparoscopy in the treatment of mid to low rectal cancer.