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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 7/2017

01-07-2017 | Review Article

Evolution of Surgical Treatment for Rectal Cancer: a Review

Authors: Sanjeev Dayal, Nick Battersby, Tom Cecil

Published in: Journal of Gastrointestinal Surgery | Issue 7/2017

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Abstract

Surgery that produces an optimal total mesorectal excision (TME) resection specimen remains the cornerstone of curative rectal cancer management. In the modern era, despite the results of recent randomised trials, laparoscopic TME is a crucial technique in the TME surgery armamentarium. Laparoscopic surgery offers the benefit of magnified views that aid sharp and precise dissection. However operating in the confines of a narrow pelvis, particularly when the mesorectum is bulky, requires significant technical skill. This is compounded by limited angulation of laparoscopic instruments and staplers. The final challenge is to preserve the integrity of the mesorectum during delivery of the specimen. The principles of TME surgery, on which Bill Heald founded the Basingstoke Colorectal unit, can equally be applied to laparoscopic, transanal and robotic TME, but great care must be taken to preserve the key principle—that no steps are taken that have the potential to shed tumour cells or compromise the quality of the mesorectal specimen.
Literature
1.
Mayo CH. Evolution in the treatment of cancer of the rectum. J Am Med Assoc. 1903;XL(17):1127–9.CrossRef
2.
Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2013;56(5):535–50.CrossRefPubMed
3.
Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet. 2000;356(9224):93–6.CrossRefPubMed
4.
Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373(9666):821–8.CrossRefPubMedPubMedCentral
5.
Heald RJ. A new approach to rectal cancer. Br J Hosp Med. 1979;22(3):277–81.PubMed
6.
Heald R. Chapter 1: The evolution of a concept: the total mesorectal excision story. In: Moran B, Heald RJ, editors. Manual of total mesorectal excision: CRC Press; 2013. p. 1–30.
7.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69(10):613–6.CrossRefPubMed
8.
9.
Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496):1479–82.CrossRefPubMed
10.
MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993;341(8843):457–60.CrossRefPubMed
11.
Moran B. Chapter 7: total mesorectal excision for rectal cancer. In: Moran B, Heald RJ, editors. Manual of Total Mesorectal Excision: CRC Press; 2013. p. 103–23.
12.
Moran BJ. Stapling instruments for intestinal anastomosis in colorectal surgery. Br J Surg. 1996;83(7):902–9.CrossRefPubMed
13.
Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg. 1997;185(2):105–13.CrossRefPubMed
14.
Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246(2):207–14.CrossRefPubMedPubMedCentral
15.
Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92(2):211–6.CrossRefPubMed
16.
McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102(5):462–79.CrossRefPubMed
17.
Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 1994;81(8):1224–6.CrossRefPubMed
18.
Battersby NJ HP, Moran B, Mercury II Study Group. A colo-anal anastomosis for an adenocarcinoma within 3 cm of the anal verge is associated with a high leak rate: experience from the MERCURY II low rectal cancer study. Abstract ESCP Meeting Belgrade. Colorectal Disease. 2013;15:13–26.
19.
20.
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–51.CrossRefPubMed
21.
Bretagnol F, Panis Y, Rullier E, Rouanet P, Berdah S, Dousset B, et al. Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg. 2010;252(5):863–8.CrossRefPubMed
22.
Veenhof AA, van der Peet DL, Meijerink WJ, Cuesta MA. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2008;247(4):718–9; author reply 9-20.CrossRefPubMed
23.
Cecil TD, Taffinder N, Gudgeon AM. A personal view on laparoscopic rectal cancer surgery. Colorectal Dis. 2006;8 Suppl 3:30–2.CrossRefPubMed
24.
Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, et al. Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg. 2012;256(6):915–9.CrossRefPubMed
25.
Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW, Jr., et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246(4):655–62; discussion 62-4.CrossRefPubMed
26.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.CrossRefPubMed
27.
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–84.CrossRefPubMed
28.
Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA. 2015;314(13):1356–63.CrossRefPubMed
29.
Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. Jama. 2015;314(13):1346–55.CrossRefPubMedPubMedCentral
30.
Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100(1):75–82.CrossRefPubMed
31.
Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372(14):1324–32.CrossRefPubMed
32.
Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010;11(7):637–45.CrossRefPubMed
33.
Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(7):767–74.CrossRefPubMed
34.
Arezzo A, Passera R, Salvai A, Arolfo S, Allaix ME, Schwarzer G, et al. Laparoscopy for rectal cancer is oncologically adequate: a systematic review and meta-analysis of the literature. Surg Endosc. 2015;29(2):334–48.CrossRefPubMed
35.
Qu H, Liu Y, Bi DS. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc. 2015;29(12):3608–17.CrossRefPubMed
36.
Lu ZR, Rajendran N, Lynch AC, Heriot AG, Warrier SK. Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival. Dis Colon Rectum. 2016;59(3):236–44.CrossRefPubMed
37.
Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253(5):890–9.CrossRefPubMed
38.
Moran BJ, Docherty A, Finnis D. Novel stapling technique to facilitate low anterior resection for rectal cancer. Br J Surg. 1994;81(8):1230.CrossRefPubMed
39.
Zhou C, Ren Y, Li J, Li X, He J, Liu P. Systematic review and meta-analysis of rectal washout on risk of local recurrence for cancer. J Surg Res. 2014;189(1):7–16.CrossRefPubMed
40.
Colombo PE, Bertrand MM, Alline M, Boulay E, Mourregot A, Carrere S, et al. Robotic versus laparoscopic total mesorectal excision (TME) for sphincter-saving surgery: is there any difference in the transanal TME rectal approach?: a single-center series of 120 consecutive patients. Ann Surg Oncol. 2016;23(5):1594–600.CrossRefPubMed
41.
Ahmed J, Kuzu MA, Figueiredo N, Khan J, Parvaiz A. Three-step standardized approach for complete mobilization of the splenic flexure during robotic rectal cancer surgery. Colorectal Dis. 2016;18(5):O171–4.CrossRefPubMed
42.
Speicher PJ, Englum BR, Ganapathi AM, Nussbaum DP, Mantyh CR, Migaly J. Robotic low anterior resection for rectal cancer: a national perspective on short-term oncologic outcomes. Ann Surg. 2015;262(6):1040–5.CrossRefPubMed
43.
Lin S, Jiang HG, Chen ZH, Zhou SY, Liu XS, Yu JR. Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol. 2011;17(47):5214–20.CrossRefPubMedPubMedCentral
44.
Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC. Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19(7):2095–101.CrossRefPubMed
45.
Xiong B, Ma L, Zhang C, Cheng Y. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. J Surg Res. 2014;188(2):404–14.CrossRefPubMed
46.
Poon JT, Law WL. Laparoscopic resection for rectal cancer: a review. Ann Surg Oncol. 2009;16(11):3038–47.CrossRefPubMed
47.
Biffi R, Luca F, Bianchi PP, Cenciarelli S, Petz W, Monsellato I, et al. Dealing with robot-assisted surgery for rectal cancer: current status and perspectives. World J Gastroenterol. 2016;22(2):546–56.CrossRefPubMedPubMedCentral
48.
Jayne DG. ACPGBI plenary research session: ROLARR trial: health economics data. Colorectal Disease. 2016;18.
49.
Heald RJ. A new solution to some old problems: transanal TME. Tech Coloproctol. 2013;17(3):257–8.CrossRefPubMed
50.
Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol. 2014;18(5):473–80.CrossRefPubMed
51.
de Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernandez M, Delgado S, et al. Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)—short-term outcomes in the first 20 cases. Surg Endosc. 2013;27(9):3165–72.CrossRefPubMed
52.
Denost Q, Adam JP, Rullier A, Buscail E, Laurent C, Rullier E. Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg. 2014;260(6):993–9.CrossRefPubMed
53.
Atallah S. Transanal total mesorectal excision: full steam ahead. Tech Coloproctol. 2015;19(2):57–61.CrossRefPubMed
54.
Buchs NC, Nicholson GA, Ris F, Mortensen NJ, Hompes R. Transanal total mesorectal excision: a valid option for rectal cancer? World J Gastroenterol. 2015;21(41):11700–8.CrossRefPubMedPubMedCentral
55.
Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP. A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis. 2016;18(1):19–36.CrossRefPubMed
56.
Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B, et al. Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg. 2015;221(2):415–23.CrossRefPubMed
57.
Deijen CL, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ES, Sietses C, et al. COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc. 2015.
58.
Hompes R, Arnold S, Warusavitarne J. Towards the safe introduction of transanal total mesorectal excision: the role of a clinical registry. Colorectal Dis. 2014;16(7):498–501.CrossRefPubMed
59.
Fernandez-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Diaz del Gobbo G, et al. Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg. 2015;261(2):221–7.CrossRefPubMed
60.
Coleman M, Rockall T. [Teaching of laparoscopic surgery colorectal. The Lapco model]. Cir Esp. 2013;91(5):279–80.CrossRefPubMed
61.
Coleman MG, Hanna GB, Kennedy R, National Training Programme L. The national training programme for laparoscopic colorectal surgery in England: a new training paradigm. Colorectal Dis. 2011;13(6):614–6.CrossRefPubMed
62.
Mackenzie H, Cuming T, Miskovic D, Wyles SM, Langsford L, Anderson J, et al. Design, delivery, and validation of a trainer curriculum for the national laparoscopic colorectal training program in England. Ann Surg. 2015;261(1):149–56.CrossRefPubMed
63.
Daniels IR, Fisher SE, Heald RJ, Moran BJ. Accurate staging, selective preoperative therapy and optimal surgery improves outcome in rectal cancer: a review of the recent evidence. Colorectal Dis. 2007;9(4):290–301.CrossRefPubMed
64.
Martling A, Cedermark B, Johansson H, Rutqvist LE, Holm T. The surgeon as a prognostic factor after the introduction of total mesorectal excision in the treatment of rectal cancer. Br J Surg. 2002;89(8):1008–13.CrossRefPubMed
65.
Wibe A, Moller B, Norstein J, Carlsen E, Wiig JN, Heald RJ, et al. A national strategic change in treatment policy for rectal cancer—implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum. 2002;45(7):857–66.CrossRefPubMed
66.
Kapiteijn E, Putter H, van de Velde CJ. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg. 2002;89(9):1142–9.CrossRefPubMed
67.
Nielsen LB, Wille-Jorgensen P. National and international guidelines for rectal cancer. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland. 2014;16(11):854–65.CrossRef
68.
Moran BJ, Holm T, Brannagan G, Chave H, Quirke P, West N, et al. The English national low rectal cancer development programme: key messages and future perspectives. Colorectal Dis. 2014;16(3):173–8.CrossRefPubMed
Metadata
Title
Evolution of Surgical Treatment for Rectal Cancer: a Review
Authors
Sanjeev Dayal
Nick Battersby
Tom Cecil
Publication date
01-07-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 7/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-017-3427-9

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