Topic: A bespoke approach to rectal cancer resection and management

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A special issue of Mini-invasive Surgery  (Online ISSN:2574-1225).

Deadline for manuscript submissions: 31 Jul 2018

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Guest Editor(s)

  • Gordon N. Buchanan, MBBS, MD, MSc, FRCS
    The Lister Hospital, London, UK.

Special Issue Introduction:

The platform or mode of resecting colorectal cancer, particularly in the rectum can influence outcome – it is not just the expertise of the primary surgeon, but also the mode of resection (open vs. laparoscopic/ robotic) that will not only predict the length of stay due to recovery but also the pathological parameters; enhanced recovery programmes further accelerate patient discharge. There are very important team factors too; the skill of assistance is magnified in laparoscopic colorectal resection where not only does the camera operator need to understand and predict steps to smooth the operation, but also a second assistant particularly in left sided resection can retract during the case thus facilitating easier dissection – however for rectal cancer resection recent trials using a non-inferiority assessment for oncological parameters have shown that patients undergoing a laparoscopic resection fared worse than those undergoing open surgery. The robotic platform for rectal cancer allows a very detailed evaluation of pelvic anatomy due to its 3D visualisation – in addition the wrist element afforded by the robot enables excellent dissection of the TME plane, akin to the early descriptions popularised by Heald et al. but with a more magnified view. It is within the confines of the pelvis that robotic resection is likely to be of greatest benefit, particularly for dissection of the mid and low rectum – the extra robotic arm can be continuously placed in a similar fashion to a St Mark’s pelvic retractor in open surgery thus enabling accurate retraction without assistance fatigue or movement as may occur in open or standard laparoscopic surgery. This should both reduce conversion to open resection for low rectal cancer and improve oncological parameters, either equivalent to, or superior to those of open resection. Lower conversion rates should enhance earlier discharge and hospital recovery and reduce costs in the longer term. Whilst some parts of the world have high rates of uptake for laparoscopic colorectal resection, others lag far behind – the use of robotic surgery currently represents a small minority of cases; going forward a tailored approach to colorectal cancer resection needs to encompass and study these important factors to achieve the best clinical and oncological outcomes for patients. In addition other modalities including Transanal total mesorectal excision (TaTME) to enable the inferior aspect of TME dissection and its place also need detailed evaluation.
The evolution of therapies in rectal cancer continues to expand allowing a unique approach through local excision, chemoradio - and contact therapy, watch and wait along with endoscopic and extended resection. This special edition aims to focus on the breadth of options available to clinicians and patients working in this arena.


Rectal, cancer, robotic, multidisciplinary, teamwork, image guided

Submission Information:

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Submission Deadline: 31 July 2018
Contacts: Lucia Jia, Assistant Editor,

Published Articles Download All Articles
  • Clinical feasibility of sphincter-preserving resection with transanal rectal dissection for low-lying rectal cancer in Japanese patients: a single-center cohort study

    Kimihiko Funahashi , Junichi Koike , Hiroyuki Shiokawa , Mitsunori Ushigome , Tomoaki Kaneko , Satoru Kagami , Takamaru Koda , Tatsuo Teramoto
    Aim: Recently, the transanal down-to-up rectal dissection, a new approach to improve the difficult total mesorectal excision (TME) for low-lying rectal cancer, has been popularized. This study assessed the long-term oncologic and functional outcomes after sphincter-preserving resection combined with transanal rectal dissection (TARD) under direct vision for both complete TME and preservation of the internal anal sphincter (IAS) as much as possible to clarify the clinical feasibility of this approach. Methods: A prospective cohort study was conducted in 90 Japanese patients between April... Read more
    This article belongs to the Special Issue A bespoke approach to rectal cancer resection and management
    Mini-invasive Surg 2018;2:27. | doi:10.20517/2574-1225.2018.28
    Published on: 28 Aug 2018  | Viewed:238  | Downloaded:15
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  • Completion proctectomy following transanal endoscopic microsurgery for early rectal cancer

    Katarina Levic-Souzani , Orhan Bulut
    Transanal endoscopic microsurgery (TEM) has proven to be a safe and effective procedure in removal of rectal lesions and may be used in treatment of early rectal cancer in selected patients. In cases when the TEM specimen shows non-radical resection, or histological high-risk factors, completion proctectomy (CP) is warranted. It is debated when it is the best time to perform CP following TEM. It is furthermore uncertain whether CP leads to an increased risk of abdominoperineal excision. Herein, we review the available literature regarding controversial issues with early completion... Read more
    This article belongs to the Special Issue A bespoke approach to rectal cancer resection and management
    Mini-invasive Surg 2018;2:25. | doi:10.20517/2574-1225.2018.35
    Published on: 16 Aug 2018  | Viewed:210  | Downloaded:10
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  • Is laparoscopic rectal surgery really not non-inferior?

    Peter F. O’Donohue , Conor D. Warren , Carina F. K. Chow
    Laparoscopic rectal surgery has gained popularity over the last 20 years. Currently there are still questions surrounding the safety and efficacy of this technique as compared to the traditional open modalities. To date, despite the initial enthusiasm for laparoscopic rectal surgery this technique is yet to reach non-inferiority in trials when compared to open resection. This review article discusses the current evidence exploring the value of laparoscopic rectal surgery. It will discuss its evolution over the last 20 years, exploring all the major randomised control trials and their... Read more
    This article belongs to the Special Issue A bespoke approach to rectal cancer resection and management
    Mini-invasive Surg 2018;2:24. | doi:10.20517/2574-1225.2018.34
    Published on: 14 Aug 2018  | Viewed:257  | Downloaded:11
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  • The role of transanal total mesorectal excision in rectal surgery

    Shlomo Yellinek , Steven D. Wexner
    Transanal total mesorectal excision (TaTME) is the newest approach for the resection of rectal cancer, according to the principles of TME. The evolution of TaTME started almost 40 years ago and is a combination of several important developments in both micro-endoscopic surgery and transanal surgery. The preliminary clinical data have revealed acceptable TME quality. Clinical trials to determine the long-term oncological results are still in process. In order to master TaTME, the surgeon should be an expert in laparoscopic rectal surgery as well as transanal microsurgery and follow a... Read more
    This article belongs to the Special Issue A bespoke approach to rectal cancer resection and management
    Mini-invasive Surg 2018;2:22. | doi:10.20517/2574-1225.2018.17
    Published on: 2 Aug 2018  | Viewed:1474  | Downloaded:76
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  • Functional results and quality of life after transanal total mesorectal excision

    Paola De Nardi
    This is a narrative review on ano-rectal, sexual, urinary, and quality of life outcomes after transanal total mesorectal excision (TME). Little is known on this topic as only a few studies are currently available in the literature. According to these, it appears that the functional results and quality of life are not substantially impaired compared with standard TME. However more data are needed to precisely assess the outcomes of this technique. Read more
    This article belongs to the Special Issue A bespoke approach to rectal cancer resection and management
    Mini-invasive Surg 2018;2:20. | doi:10.20517/2574-1225.2018.30
    Published on: 24 Jul 2018  | Viewed:667  | Downloaded:36
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  • Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

    Naveena A. N. Kumar , Praveen Kammar , Avanish Saklani
    Minimal invasive surgery (MIS) is an accepted modality of treatment for rectal cancer. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center. However, safety and feasibility of laparoscopic surgery and robotic surgery in beyond total mesorectal excision (b-TME) and extended TME (e-TME) are not well established. This review summarizes the current evidence for MIS approach for b-TME/extended... Read more
    This article belongs to the Special Issue A bespoke approach to rectal cancer resection and management
    Mini-invasive Surg 2018;2:19. | doi:10.20517/2574-1225.2018.26
    Published on: 23 Jul 2018  | Viewed:604  | Downloaded:14
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  • Is robotic rectal resection the preferred option for resectable cancer?

    Hanumant Chouhan , James Shin , Seon-Hahn Kim
    The ultimate goal of rectal cancer surgery is to achieve a negative circumferential, distal resection margin and intact mesorectal excision; however, controversy remains as to what is the best approach. Based on the current evidence, open surgery remains the “gold standard”, however recent improvements in minimally invasive surgery (MIS) techniques with the introduction of robotic surgery and transanal total mesorectal excision have questioned the historical approach of open rectal dissection. A robotic system (da Vinci) overcomes many of the limitations of laparoscopic surgery. A robotic... Read more
    This article belongs to the Special Issue A bespoke approach to rectal cancer resection and management
    Mini-invasive Surg 2018;2:18. | doi:10.20517/2574-1225.2018.40
    Published on: 20 Jul 2018  | Viewed:452  | Downloaded:17
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  • The treatment of early rectal cancer in the era of adjuvant and neo-adjuvant therapy

    Michael G. Thomas , David E. Messenger , Katherine Gash
    The accurate staging of rectal cancer improves the stratification of patients for adjuvant therapy. Staging of tumor with endoluminal ultrasonography (EUS) shows a good correlation with histology (κ = 0.85; 95% confidence interval 0.76-0.95). Overall pT and pN stage accuracy of EUS was 92% and 65% respectively. The staging of local disease can be further augmented by EUS guided fine needle aspiration of extra rectal lesions lying within or outside of the mesorectum. In a systematic review of local excision after neoadjuvant therapy a total of 22 unique studies reporting on 1068 patients... Read more
    This article belongs to the Special Issue A bespoke approach to rectal cancer resection and management
    Mini-invasive Surg 2018;2:17. | doi:10.20517/2574-1225.2018.25
    Published on: 18 Jul 2018  | Viewed:349  | Downloaded:15
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Mini-invasive Surgery ISSN 2574-1225 (Online)
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