Total mesorectal excision: from open to laparoscopic approach

Abstract

Rectal cancer surgery has undergone a rapid evolution in the last few decades. Adoption of total mesorectal excision (TME) dramatically reduced the local recurrence rate and improved the survival rate. TME became the standard procedure for cancer of the middle and lower rectum soon after its introduction. The use of laparoscopic approach in resection of colorectal cancer started in the early 1990s. Laparoscopic resection for colon cancer was widely advocated subsequently as most randomized trials had proven that the oncological outcome comparable to that of open colectomy could be achieved, in addition to the intrinsic benefits of minimally invasive surgery. Rectal cancer was rarely included in early randomized trials comparing laparoscopic and open surgery because of the relative complexity of rectal cancer resection, in particular, TME. The first laparoscopic TME was only reported in 2001. Concerns about oncological safety of laparoscopic TME existed as there were limited studies to compare the long-term outcomes of laparoscopic and open TME on a randomized setting.