Laparoscopic Procedures: Laparoscopic Low Anterior Resection

  • Skandan ShanmuganEmail author
  • Bradley J. Champagne


Laparoscopic colectomy has been proven to be equivalent to conventional open surgery, while minimally invasive rectal surgery has been much delayed. The challenges to laparoscopic rectal surgery include the steep technical learning curve and poorly defined indications and contraindications for resection. Despite these challenges, laparoscopic rectal surgery can often enhance the pelvic dissection and is safe and feasible in skilled hands and can achieve unequivocally excellent results. This chapter will outline the current evidence for laparoscopy as a treatment option for patients with rectal cancer and highlight the technical details of performing a laparoscopic low anterior resection.


Laparoscopic surgery Minimally invasive rectal surgery Low anterior resection Rectal cancer LAR 


  1. 1.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Colon Cancer Laparoscopic or Open Resection Study G, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10(1):44–52.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart Jr RW, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246(4):655–62. discussion 62-4.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, et al. Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg. 2012;256(6):915–9.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Nussbaum DP, Speicher PJ, Ganapathi AM, Englum BR, Keenan JE, Mantyh CR, Migaly J. Laparoscopic versus open low anterior resection for rectal cancer: results from the National Cancer Data Base. J Gastrointest Surg. 2015;19(1):124–31.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Kiran RP, Lian L. Lavery IC Does a subcentimeter distal resection margin adversely influence oncologic outcomes in patients with rectal cancer undergoing restorative proctectomy? Dis Colon Rectum. 2011;54(2):157–63.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2013;56(5):667–78.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg. 1997;185(2):105–13.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Marusch F, Koch A, Schmidt U, et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum. 2002;45(9):1164–71.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg. 1996;182(6):495–502.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Lindsey I, Mortensen NJ. Iatrogenic impotence and rectal dissection. Br J Surg. 2002;89(12):1493–4.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Heriot AG, Tekkis PP, Constantinides V, Paraskevas P, Nicholls RJ, Darzi A, Fazio VW. Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection. Br J Surg. 2006;93(1):19–32.CrossRefPubMedCentralGoogle Scholar

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Authors and Affiliations

  1. 1.Division of Colon and Rectal SurgeryPerelman School of Medicine, Pennsylvania Hospital, University of PennsylvaniaPhiladelphiaUSA
  2. 2.Division of Colorectal Surgery, Department of SurgerySt. John Medical Center, Digestive Health Institute, Community Gastroenterology and Quality CenterClevelandUSA

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