Robotic multi-visceral resection for locally-advanced rectal cancer – an international multicenter study.

Cancers originating within 15 cm of the anal verge are defined as rectal cancers. They are quite common cancers in the western world and comprise about one quarter of all the colorectal cancers. The mainstay of treatment of these cancers is surgery either with or without neoadjuvant therapy (chemo- or radiotherapy). The surgical techniques have evolved over time in order to improve outcomes. There was a time when abdominoperineal excision of rectum was considered gold standard for low rectal cancers. Leaving everyone with a permanent colostomy and, despites having had treatment, with poor survival rates. Since the introduction of the TME surgery (Total Mesorectal Excision) by Heald et al. in 1982, the oncological outcome of rectal cancer patients has improved significantly. Improvement of the surgical technique in combination with the advent of modern instruments facilitated sphincter saving low and ultra-low anterior resections. During the same time as the introduction of the TME surgery,in the late 80’s, minimal invasivelaparoscopic colorectal surgery started and lead to significant improvements in the short term postoperative outcomes. Since 1992 the laparoscopic approach was applied to rectal cancer with promising results.However, there was criticism on the laparoscopic approach, based on a long learning curve, high conversion rates, lack of flexibility of the instruments and limited hand eye coordination with lack of tactile perception. In order to overcome these limitations, more recently, other minimal invasive techniques, such as robotic (assisted) surgery and the trans-anal approach (TaTME)were introduced as an alternative to laparoscopic surgery for better patient outcomes.The debate whether robotic assisted surgery is superior to laparoscopic surgery is anongoing debate without a clear answer at this moment in favour of either one of the techniques.The lack of significant difference between the two approaches might be caused by surgical trials being performed with robotic surgeons still in the beginning of their learning curve.The debate whether robotic assisted surgery is superior to laparoscopic surgery is anongoing debate without a clear answer at this moment in favour of either one of the techniques.The lack of significant difference between the two approaches might be caused by surgical trials being performed with robotic surgeons still in the beginning of their learning curve.