Is Laparoscopic Rectal Surgery the Gold Standard?

Abstract

The last two decades have seen a gradual but shifting enthusiasm for laparoscopic general surgery. A better appreciation of the laparoscopic approach with adaptation of open surgical techniques and improvements in instrumentation has helped this transition. A realization of the patient benefits that can be gained from laparoscopic surgery in benign disease has increased interest in its application in cancer surgery. Colorectal surgery, by its very nature, is challenging for the laparoscopic approach, involving multi-quadrant dissection, manipulation of bulky tissues and a dependency on assistants for retraction. In rectal cancer, the situation is made more difficult by the confines of the bony pelvis, the proximity of vital structures and the precision demanded to achieve complete tumour resection with an intact mesorectum and preservation of pelvic autonomic nerves. For colon cancer, there has been a general recognition for some time that laparoscopic surgery can produce oncological outcomes at least equivalent to open surgery, but with the added advantages of quicker patient recovery and shorter hospital stay. In this chapter, we will explore the evolution of laparoscopic colorectal surgery, with particular emphasis on rectal cancer, and ask whether laparoscopic rectal cancer surgery has acquired the same acceptance as colon cancer to become the new ‘gold standard’.