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O’Donohue et al. Mini-invasive Surg 2018;2:24 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.34

Review Open Access

Is laparoscopic rectal surgery really not non-
inferior?

Peter F. O’Donohue , Conor D. Warren , Carina F. K. Chow 1,2
1
1,2
1 Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia.
2 Wesley Hospital, Auchenflower, QLD 4066, Australia.

Correspondence to: Dr. Carina F. K. Chow, Colorectal Unit, Royal Brisbane and Women’s Hospital, Bowen Bridge Road &
Butterfield St, Herston, QLD 4029, Australia. E-mail: Carina.Chow@health.qld.gov.au

How to cite this article: O’Donohue PF, Warren CD, Chow CFK. Is laparoscopic rectal surgery really not non-inferior? Mini-
invasive Surg 2018;2:24. http://dx.doi.org/10.20517/2574-1225.2018.34

Received: 31 May 2018 First Decision: 11 Jul 2018 Revised: 17 Jul 2018 Accepted: 20 Jul 2018 Published: 14 Aug 2018
Science Editor: Gordon N. Buchanan Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Laparoscopic rectal surgery has gained popularity over the last 20 years. Currently there are still questions surrounding
the safety and efficacy of this technique as compared to the traditional open modalities. To date, despite the initial
enthusiasm for laparoscopic rectal surgery this technique is yet to reach non-inferiority in trials when compared to open
resection. This review article discusses the current evidence exploring the value of laparoscopic rectal surgery. It will
discuss its evolution over the last 20 years, exploring all the major randomised control trials and their results. It is our
belief that laparoscopic rectal surgery for malignancy is not non-inferior to conventional open surgery.

Keywords: Rectal cancer, laparoscopic, open surgery, non-inferior, survival rate

INTRODUCTION
[1]
In Western society, rectal cancer is the third most common cause of cancer related deaths . It encompass-
[2]
es approximately 30% of all colorectal malignancies . Surgical resection of the rectum remains pivotal to
[3,4]
the successful management of rectal cancer, especially in stage II or III disease .
The treatment of rectal cancer has undergone significant change over the last 50 years. Prior to total me-
sorectal excision (TME) rectal cancer had a locoregional recurrence rate of 40% and 5-year survival of less
[5,6]
than 50% . It was revolutionised in the early 1980’s by Heald, who demonstrated that TME significantly
improved the outcomes and prognosis for patients being treated for rectal cancer . TME is the precise sur-
[6]
gical dissection technique which involves the complete removal of the rectum, together with its draining

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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