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Total Mesorectal Excision: Open, Laparoscopic or Robotic

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Early Gastrointestinal Cancers II: Rectal Cancer

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 203))

Abstract

Goals Total mesorectal excision (TME) is the gold standard technique for the surgical treatment of rectal cancer. Despite the benefits of minimally invasive surgery, laparoscopic TME (LTME) is a technically challenging procedure with a long learning curve. Robotic TME (RTME) has been advocated as an alternative to conventional LTME, but large studies supporting the efficacy or RTME are scarce. This work will review the current literature on minimally invasive surgery for rectal cancer and discuss future directions in the field. Methods A review of recent large single and multicenter studies on minimally invasive surgery for rectal cancer was conducted. Results Based on two large randomized clinical studies (CLASICC (Green et al. 2013) and COLOR II (van der Pas et al. 2013)). LTME is safe and feasible for the treatment of rectal cancer. Compared to open surgery, LTME has been shown to result in superior postoperative outcomes and similar oncologic results. However, the conversion rate of LTME is around 17 %. The literature supporting RTME is more limited. Robotic rectal resection appears to have similar postoperative and oncologic outcomes compared to LTME. RTME results in higher costs and possibly lower conversion rates. A large randomized clinical trial (ROLARR) comparing robotic to laparoscopic surgery for rectal cancer is underway. Conclusions Despite the technical challenges, current data supports the use of minimally invasive technique for rectal cancer surgery with superior short-term outcomes compared to an open approach. The use of robotic surgery is promising, but still limited and awaiting the conclusion of randomized clinical trials.

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Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, University of California, Irvine, Orange, CA, USA

    Monica Young & Alessio Pigazzi

  2. Department of Colon and Rectal Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA

    Alessio Pigazzi

Authors
  1. Monica Young
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  2. Alessio Pigazzi
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Correspondence to Alessio Pigazzi .

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Editors and Affiliations

  1. Department of Medical Oncology, Tumor- und Brustzentrum ZeTuP, St. Gallen, Switzerland

    Florian Otto

  2. Caritasklinik St. Theresia, Saarbrücken, Germany

    Manfred P. Lutz

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Young, M., Pigazzi, A. (2014). Total Mesorectal Excision: Open, Laparoscopic or Robotic. In: Otto, F., Lutz, M. (eds) Early Gastrointestinal Cancers II: Rectal Cancer. Recent Results in Cancer Research, vol 203. Springer, Cham. https://doi.org/10.1007/978-3-319-08060-4_6

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  • DOI: https://doi.org/10.1007/978-3-319-08060-4_6

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  • Online ISBN: 978-3-319-08060-4

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