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Chen et al. Mini-invasive Surg 2018;2:42 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.59

Review Open Access

Quality of life after minimally invasive surgery for
rectal cancer

Jason H. Chen , Jennifer M. Ayscue , Mohammed Bayasi , James F. Fitzgerald , Thomas J. Stahl ,
1
2
1
1
1
Brian L. Bello 1,2
1 Colorectal Surgery Program at MedStar Washington Hospital Center, Washington, DC 20010, USA.
2 Department of Surgery, MedStar Georgetown University Hospital, Washington, DC 20010, USA.
Correspondence to: Dr. Brian L. Bello, Colorectal Surgery Program at MedStar Washington Hospital Center, 106 Irving St NW,
Suite 2100 North, Washington, DC 20010, USA. E-mail: brian.l.bello@medstar.net
How to cite this article: Chen JH, Ayscue JM, Bayasi M, Fitzgerald JF, Stahl TJ, Bello BL. Quality of life after minimally invasive
surgery for rectal cancer. Mini-invasive Surg 2018;2:42. http://dx.doi.org/10.20517/2574-1225.2018.59

Received: 28 Aug 2018 First Decision: 17 Oct 2018 Revised: 30 Oct 2018 Accepted: 30 Oct 2018 Published: 30 Nov 2018

Science Editor: Gordon N. Buchanan Copy Editor: Cui Yu Production Editor: Huan-Liang Wu

Abstract
Traditional open surgical technique for rectal cancer is associated with significant morbidity and impact on quality
of life. Multiple structures are at risk during total mesorectal excision, which may have profound impact on sexual
function, and urinary and fecal continence. In addition, having a temporary or permanent ostomy can have a significant
effect on overall well-being. Patients have reported post-operative problems such as chronic wounds, poor body image,
inhibited work and social function. Minimally invasive surgery (MIS) is an evolving component of colon and rectal
cancer treatment that may have benefits over open surgery. The increasing role of laparoscopy for colon and rectal
cancer has been associated with decreased morbidity, improved pain control, and reduced length of stay. However,
laparoscopic surgery in rectal cancer remains technically difficult due to the inherent limitations of operating in the
pelvis. Robotic surgery is a newer method for treating rectal cancer developed to overcome these limitations. Transanal
endoscopic microsurgery and transanal MIS are techniques to achieve local excision, avoiding proctectomy in select
patients, potentially improving functional outcomes. Transanal total mesorectal excision is an even newer technique to
facilitate dissection of low rectal cancers. Controversy remains about equivalence in oncologic outcomes when these
MIS approaches are used for rectal cancer. Even more unclear is the effect of MIS approaches on quality of life and how
they compare to open surgery. This review discusses the most current evidence on the impact of various MIS techniques
on quality of life after rectal cancer surgery.

Keywords: Quality of life, rectal cancer, minimally invasive surgery, laparoscopic, robotic, transanal endoscopic
microsurgery, transanal minimally invasive surgery, transanal total mesorectal excision

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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