Current status of laparoscopic total mesorectal excision

Background: Rectal cancer is a common malignancy with considerable mortality. This review outlines the current status of laparoscopic total mesorectal excision as a treatment option for rectal cancer and emphasizes the need for standardized approaches.

Methods: We searched PubMed for the terms "total mesorectal excision," "rectal cancer," and "laparoscopic surgery" used in the literature between 1993 and 2010. Additional material regarding the latest statistics from the American Cancer Society, reports from the Cochrane Database of Systemic Reviews, and meta-analyses also were searched.

Results: Ninety-six articles were selected: (1) 22 randomized controlled trials, (2) 25 nonrandomized comparative studies, (3) 31 case series, (4) 14 reviews, and (5) 1 report from the Cochrane Database of Systemic Reviews; 3 meta-analyses also were reviewed. Exclusion criteria included non-English language articles and case reports.

Conclusions: At present, open resection is still the standard in rectal cancer and the role of laparoscopy is yet to be defined. The benefits of laparoscopic total mesorectal excision have been clearly translated in the surgical management of rectal cancer. Unfortunately, the lack of reports from larger prospective randomized studies have hindered its use so far.