An update on minimally invasive surgical approaches for rectal cancer.

This study reviewed the current minimally invasive surgical (MIS) approaches for the treatment of patients with rectal cancer (RC).

Rectal cancer (RC) is one of the most common types of cancer worldwide. RC involves the final part of the large intestine or rectum. RC can be treated by surgical removal of the tumor. Some patients receive chemotherapy before surgery to shrink the tumor so complete removal of the tumor is possible. 

There are different types of surgery to remove the rectal tumor. In MIS, doctors use small incisions (cuts) and few stitches to operate with less damage to the body than with open surgery. Laparoscopic surgery (LS) involves a surgeon manually removing the tumor using a camera to guide them through small incisions. Robotic surgery (RS) involves the surgeon using a computer to move the surgical tools to remove the tumor. In RS, the surgeon has a better range of motion with the tools and can get more accurate images with the camera. Open surgery (OS) involves a larger incision in the abdomen to remove the tumor.

This review was conducted to update the current role of MIS in the treatment of RC, highlighting short- and long-term outcomes from the latest studies.

LS has been shown to have fewer complications and faster healing compared to OS. The benefits of LS over OS include less blood loss during operation, faster return of bowel function, and shorter length of stay in the hospital, and equivalent oncological outcomes. However, different studies have shown that it may not be associated with the same oncological benefit as OS.

Damage to urinary and sexual functions are well-known complications of rectal surgery. LS was found to be associated with higher rates of sexual dysfunction when compared to OS. LS had similar long-term outcomes like overall survival, survival without cancer progression, and quality of life when compared to OS.

Long-term outcome data of patients undergoing RS are still limited. Studies comparing LS to RS found no significant differences in terms of the average time of operation. One study concluded that patients with RC who underwent RS had better urinary and sexual function than those who had LS.

A study found that patients treated with an MIS approach had increased overall survival rates after 1- and 5-years when compared to those who were treated with OS. MIS approach was associated with decreased rates of cancer cells left behind the tumor site following surgery and increased likelihood of examining more than 12 lymph nodes (accurate diagnosis of RC) when compared to OS.

Several barriers have delayed the adoption of MIS as a standard of care for the treatment of RC. Technical difficulties, steep learning curves, and questionable cost-effectiveness are some of the key challenges.

This review provided updates to the current surgical approaches for the treatment of patients with RC.