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Kumar et al. Mini-invasive Surg 2018;2:19 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.26

Review Open Access

Minimal invasive approach for beyond total
mesorectal excision/extended resections in rectal

cancer

Naveena A. N. Kumar, Praveen Kammar, Avanish Saklani

Department of Colorectal Surgical Oncology and Robotic Surgery, Tata Memorial Centre, Mumbai, Maharashtra 400012, India.
Correspondence to: Dr. Avanish Saklani, Department of Colorectal Surgical Oncology and Robotic Surgery, Tata Memorial
Centre, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012, India. E-mail: asaklani@hotmail.com
How to cite this article: Kumar NAN, Kammar P, Saklani A. Minimal invasive approach for beyond total mesorectal excision/
extended resections in rectal cancer. Mini-invasive Surg 2018;2:19. http://dx.doi.org/10.20517/2574-1225.2018.26

Received: 15 May 2018 First Decision: 2 Jul 2018 Revised: 7 Jul 2018 Accepted: 9 Jul 2018 Published: 23 Jul 2018
Science Editor: Gordon N. Buchanan Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
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 resections in rectal cancer. A systematic search was carried out in PubMed. Studies available in
English related to MIS approach in b-TME/e-TME in rectal cancers were identified and evaluated. This review concludes
MIS is feasible with good perioperative outcomes in b-TME/e-TME in carefully selected patients. Laparoscopic surgery
has considerable learning curve and should be performed by experienced surgical teams. Robotic surgery is feasible and
beneficial in complex resection in pelvis. However, evidence for long-term oncological outcomes of MIS in b-TME/e-TME
is low and needs to be studied further by randomized controlled trial once enough numbers are possible in institutes
with high volume rate.

Keywords: Minimal invasive surgery, laparoscopic surgery, robotic surgery, beyond total mesorectal excision, extended
resection, locally advanced rectal cancer, pelvic exenteration, lateral pelvic lymph node dissection

INTRODUCTION
Total mesorectal excision (TME) is a standard of care for primary rectal cancer located within mesorectal
fascia. In locally advanced and locally recurrent tumors extending beyond mesorectal fascia, removal of

© 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
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