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IJGII012 Suppl01 22

The document discusses recent advancements in the surgical treatment of colorectal cancer, highlighting the safety and feasibility of laparoscopic colectomy and rectal cancer surgery. It emphasizes the benefits of minimally invasive techniques, such as reduced recovery time and improved oncologic outcomes, while also addressing challenges like the learning curve and conversion rates to open surgery. Additionally, it mentions the exploration of robotic surgery and transanal approaches as emerging methods in colorectal cancer management.

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0% found this document useful (0 votes)
15 views2 pages

IJGII012 Suppl01 22

The document discusses recent advancements in the surgical treatment of colorectal cancer, highlighting the safety and feasibility of laparoscopic colectomy and rectal cancer surgery. It emphasizes the benefits of minimally invasive techniques, such as reduced recovery time and improved oncologic outcomes, while also addressing challenges like the learning curve and conversion rates to open surgery. Additionally, it mentions the exploration of robotic surgery and transanal approaches as emerging methods in colorectal cancer management.

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Int J Gastrointest Interv 2023;12:S22–S23

International Journal of Gastrointestinal Intervention


journal homepage: www.ijgii.org

A Multidisciplinary Approach to Colorectal Cancer


Recent updates in the surgical treatment of colorectal cancer
Seung-Bum Ryoo
Division of Colorectal Surgery, Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Copyright © 2023, Society of Gastrointestinal Intervention.

Introduction than laparoscopic surgery.11 Transanal approach. To manage the


complexity of low rectal cancer surgery, transanal total mesorec-
Laparoscopic colectomy has been widely spread in the world tal excision (TaTME) has recently gained traction, suggesting to
from the early 2000. Numerous randomized controlled trials had be feasible with conversion rates to open surgery and operative
revealed the laparoscopic colectomy is safe and feasible. Short- times comparable to laparoscopic TME.12,13 However, there might
term benefits, which are less scar, less pain and earlier recovery of be a stiff learning curve and the oncologic superiority should be
bowel motility, and long-term can be better in minimally invasive proven in ongoing trials.14,15
surgery and long-term survival is also not different to open sur- The recent advancement of surgical treatment of colorectal
gery.1-3 Laparoscopic surgery for colon cancer had been proven cancer is very glorious. Many technical developments are still on-
to be safe and feasible through randomized clinical trials in many going, and absolutely, those can be advantageous for improving
countries, and in particular, it has the advantage of fast recovery the outcomes of patients’ wellbeing.
after surgery.1-6 Recently, radical lymph node dissection in supe-
rior mesenteric vessel area, which is called complete mesorectal References
excision (CME), can be performed by laparoscopic surgery, and
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improve the oncologic survival outcomes.7 J. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-
Laparoscopic rectal cancer surgery is also already established metastatic colon cancer: a randomised trial. Lancet 2002;359:2224-9.
to be safe and feasible. We have the main authors for COREAN 2. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown
JM, group MCt. Short-term endpoints of conventional versus laparoscopic-assisted
trial, which is the landmark trial to establish that the laparoscopic surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, ran-
low anterior resection is safe and feasible when it is performed domised controlled trial. Lancet 2005;365:1718-26.
by the experienced surgeons. Long-turm survival was also good 3. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahl-
and not different. However, some other studies did not fulfill the man L, Cuesta MA, Msika S, Morino M, Lacy AM, Group COcLoORS. Laparoscopic
surgery versus open surgery for colon cancer: short-term outcomes of a ran-
safety of this laparoscopic LAR and non-inferiority was not estab- domised trial. Lancet Oncol 2005;6:477-84.
lished with relatively high conversion rate. In laparoscopic LAR, 4. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM. The
there are some disadvantages of limitation of motion, no joint long-term results of a randomized clinical trial of laparoscopy-assisted versus
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action and steep learning curve. Robotic surgery insist they can 5. Clinical Outcomes of Surgical Therapy Study G, Nelson H, Sargent DJ, Wieand HS,
overcome those disadvantages in some extents, but I think it’s not Fleshman J, Anvari M, Stryker SJ, Beart RW, Jr., Hellinger M, Flanagan R, Jr., Pe-
perfect yet. To overcome the disadvantages of laparoscopic sur- ters W, Ota D. A comparison of laparoscopically assisted and open colectomy for
colon cancer. N Engl J Med 2004;350:2050-9.
gery, the hand-held multi articulated instrument was developed. 6. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM,
The advantages of this flexible instrument is absolute in trimming Brown JM, Group UMCT. Randomized trial of laparoscopic-assisted resection of
of far distal rectum in both side of corner just before the rectal colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin
Oncol 2007;25:3061-8.
transection. The operation time was decreased in case of using the 7. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized
flexible multi articulated instrument. surgery for colonic cancer: complete mesocolic excision and central ligation-
Robotic surgery had been attempted to overcome the disad- -technical notes and outcome. Colorectal Dis 2009;11:354-64; discussion 64-5.
8. Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Buchler MW. Robot-assisted
vantages of limitation of motion, no joint action and steep learn- abdominal surgery. Br J Surg 2004;91:1390-7.
ing curve in laparoscopic surgery.8,9 However, ROLLAR trial could 9. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current
not verify the advantages of robotic rectal cancer surgery com- perspective. Ann Surg 2004;239:14-21.
10. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West
pared to laparoscopic surgery with presenting similar conversion N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C,
rates.10 There might be some other disadvantages of high cost, Brown J. Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk
bulky platform, no tactile sense, limited instruments and longer of Conversion to Open Laparotomy Among Patients Undergoing Resection for
Rectal Cancer: The ROLARR Randomized Clinical Trial. JAMA 2017;318:1569-80.
operation time in robotic surgery. Recent COLLAR trial also could 11. Park JS, Lee SM, Choi GS, Park SY, Kim HJ, Song SH, Min BS, Kim NK, Kim SH,
not confirm the improvement of TME quality in robotic surgery Lee KY. Comparison of Laparoscopic Versus Robot-Assisted Surgery for Rectal

pISSN 2636-0004 eISSN 2636-0012 https://doi.org/10.18528/ijgii23S0402


This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Seung-Bum Ryoo / Recent updates in the surgical treatment of colorectal cancer S23
Cancers: The COLRAR Randomized Controlled Trial. Ann Surg 2023;278:31-8. 14. Deijen CL, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ES, Sietses C, Tuyn-
12. Munini M, Popeskou SG, Galetti K, Roesel R, Mongelli F, Christoforidis D. Trans- man JB, Lacy AM, Hanna GB, Bonjer HJ. COLOR III: a multicentre randomised
anal (TaTME) vs. laparoscopic total mesorectal excision for mid and low rectal clinical trial comparing transanal TME versus laparoscopic TME for mid and low
cancer: a propensity score-matched analysis of early and long-term outcomes. Int rectal cancer. Surg Endosc 2016;30:3210-5.
J Colorectal Dis 2021;36:2271-9. 15. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran
13. Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection B, Hanna GB, Mortensen NJ, Tekkis PP, Ta TMERC. Transanal Total Mesorec-
using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc tal Excision: International Registry Results of the First 720 Cases. Ann Surg
2010;24:1205-10. 2017;266:111-7.

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