Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer

摘要

The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in recent multicenter randomized clinicaltrials (RCTs). The MRC-CLASSIC, COLOR II, and COREAN trials found no differences in local recurrence or diseasefreesurvival rate between laparoscopic and open surgery. However, the noninferiority of laparoscopic surgery with respectto open surgery for rectal cancer was not established on statistical analysis in the ACOSOG Z6051 and the ALaCaRTtrials. Quality of total mesorectal excision (TME) is one of the most important prognostic factors. Incomplete TMEhad unfavorable oncologic outcomes compared to complete TME. Although TME quality can be clearly identified onpathologic evaluation, there is controversy regarding the acceptable range of oncologically safe TME for laparoscopic surgery.It is not certain whether near-complete TME has an unfavorable oncologic impact and whether laparoscopic surgerywith near-complete TME is an oncological threat. Therefore, the surgical community will be interested in the long-termoutcomes and meta-analyses of ongoing large-scale RCTs. Laparoscopic rectal cancer surgery has been steadily improvingits safety for oncology surgery, which has been reported consistently in various multicenter RCTs. To improve surgicalquality, colorectal surgeons should choose the most appropriate surgical technique, including laparoscopic surgery.