The use of laparoscopy for locally advanced rectal cancer.

INTRODUCTION: In the last decades, the use of minimally invasive surgery has dramatically increased for the treatment of rectal cancer. However, no clear evidence exists on the role of laparoscopy for locally advanced rectal cancer, especially for cT4 tumors, after neoadjuvant therapy.

EVIDENCE ACQUISITION: A literature search was performed on Embase, Medline, and Cochrane databases to identify relevant studies published up to November 2017 analyzing the outcomes of laparoscopic surgery for locally advanced rectal cancer.

EVIDENCE SYNTHESIS: Systematic reviews and meta-analyses showed that laparoscopic proctectomy is associated with faster recovery compared to open approach while oncologic and survival outcomes are equivalent. However, concerns still exist on the quality of laparoscopic mesorectal excision. In the majority of the available studies, cT4 tumors were not included, but based on few retrospective series in tertiary referral centers laparoscopic rectal resection of T4 rectal cancer appeared to be safe and feasible, with faster recovery and adequate oncologic outcomes. Robotics and transanal approaches are promising minimally invasive alternatives.

CONCLUSIONS: Locally advanced rectal cancers require multidisciplinary management including neoadjuvant chemo-radiotherapy and surgery. Preoperative re-staging may be useful to plan the best surgical procedure. Minimally invasive surgery, especially laparoscopy, can provide adequate outcomes in selected patients with locally advanced rectal cancer with the advantage of faster recovery compared to open surgery. However, the overall evidence is poor, and further studies are needed to elucidate the role of minimally invasive surgery for cT4 rectal cancer.