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in colorectal surgery in the past 20 years, with established benefits in short-term outcomes and return to
function. Laparoscopic rectal surgery can promote patient recovery, overall outcome, and quality of life.
Appropriate training is essential to achieve results that are at least comparable with oncological results.
Most importantly, the concerns and controversies regarding oncological outcomes with laparoscopic TME
should be resolved with the publication of the results of the studies evaluating long-term survival with this
surgical approach.

CONCLUSION
TME, which should be performed to preserve the nerves and ureters, is technically difficult to perform in
the pelvis. The surrounding tissues can be visualized more clearly with the laparoscopic approach; how-
ever, the angulation of the laparoscopic instruments and endoscopic staples is limited. Therefore, at least
50 laparoscopic rectal surgeries must be performed to achieve proper experience with this technique. The
results of the studies published to date reveal that there is no difference in short-term outcomes between
the laparoscopic and open approach. The long-term results of the limited number of trials conducted to
date reported that the outcomes were similar between the two surgical groups; however, concerns remain
regarding the utility of laparoscopy in locally advanced and distal rectal cancer, which should be addressed
by evaluating long-term outcomes with additional randomized controlled trials.

DECLARATIONS
Authors’ contributions
Both authors contributed to the conception and the design of the review.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflict of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.

REFERENCES
1. Nienhüser H, Heger P, Schmitz R, Kulu Y, Diener MK, Klose J, Schneider M, Müller-Stich BP, Ulrich A, Büchler MW, Mihaljevic AL,
Schmidt T. Short- and long-term oncological outcome after rectal cancer surgery: a systematic review and meta-analysis comparing
open versus laparoscopic rectal cancer surgery. J Gastrointest Surg 2018;22:1418-33.
2. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg 1982;69:613-6.
3. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991;1:144-
50.
4. Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, Beart RW
Jr, Hellinger M, Flanagan R Jr, Peters W, Ota D. A comparison of laparoscopically assisted and open colectomy for colon cancer. N
Engl J Med 2004;350:2050-9.
5. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM;