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Front Oncol. 2014 May 6;4:98. doi: 10.3389/fonc.2014.00098. eCollection 2014.

Laparoscopic and robotic total mesorectal excision in the treatment of rectal cancer. Brief review and personal remarks.

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Unit of Minimally Invasive Surgery, European Institute of Oncology , Milan , Italy.
Unit of Abdominal Integrated Surgery, European Institute of Oncology , Milan , Italy.
Division of Abdomino-Pelvic Surgery, European Institute of Oncology , Milan , Italy.
Department of General and Oncologic Surgery, Azienda Ospedaliera SS Antonio e Biagio , Alessandria , Italy.
Division of General Surgery, Istituto Clinico Humanitas, School of Medicine, University of Milan , Rozzano , Italy.


The current standard treatment for rectal cancer is based on a multimodality approach with preoperative radiochemotherapy in advanced cases and complete surgical removal through total mesorectal excision (TME). The most frequent surgical approach is traditional open surgery, as laparoscopic TME requires high technical skill, a long learning curve, and is not widespread, still being confined to centers with great experience in minimally invasive techniques. Nevertheless, in several studies, the laparoscopic approach, when compared to open surgery, has shown some better short-term clinical outcomes and at least comparable oncologic results. Robotic surgery for the treatment of rectal cancer is an emerging technique, which could overcome some of the technical difficulties posed by standard laparoscopy, but evidence from the literature regarding its oncologic safety and clinical outcomes is still lacking. This brief review analyses the current status of minimally invasive surgery for rectal cancer therapy, focusing on oncologic safety and the new robotic approach.


laparoscopic surgery; neoadjuvant therapy; rectal cancer; robotic surgery; total mesorectal excision

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