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| 1 | Laparoscopic surgery for rectal cancer:The state of the art显示文摘At present time,there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions,lower morbidity rate and earlier recovery compared to open surgery.Technical limitations and a steep learning curve have limited the wide application of miniinvasive surgery for rectal cancer.The present article discusses the current status of laparoscopic resection for rectal cancer.A review of the more recent retrospective,prospective and randomized controlled trial(RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed.A particular emphasis was dedicated to mid and low rectal cancers.Few prospective and RCT trials specif ically addressing laparoscopic rectal cancer resection are currently available in the literature.Improved short-term outcomes in term of lesser intraoperative blood loss,reduced analgesic requirements and a shorter hospital stay have been demonstrated.Concerns have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential margin.This data however was not conf irmed by other prospective comparative studies.Moreover,a similar local recurrence rate has been reported in RCT and comparative series.Similar f indings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any def initive conclusions.On the basis of available data in the literature,the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local recurrence.With respect to longterm survival,a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue. | Carlo Staudacher Andrea Vignali | 2010 | World Journal of Gastrointestinal Surgery2010，2，9： | 16 |
| 2 | Superiority of laparoscopic rectal surgery:Towards a new era显示文摘While laparoscopic colon surgery has been established to some degree over this decade,laparoscopic rectal surgery is not standard yet because of the difficulty of making a clear surgical field,the lack of precise anatomy of the pelvis,immature procedures of rectal transaction and so on.On the other hand,maintaining a clear surgical field via the magnified laparoscopy may allow easier mobilization of the rectum as far as the levetor muscle level and may result less blood loss and less invasiveness.However,some unique techniques to keep a clear surgical field and knowledge about anatomy of the pelvis are required to achieve the above superior operative outcomes.This review article discusses how to keep a clear operative field,removing normally existing abdominal structures,and how to transact the rectum and restore the discontinuity based on anatomical investigations.According to this review,laparoscopic rectal surgery will become a powerful modality to accomplish a more precise procedure which has been technically impossible so far,actually entering a new era. | Yosuke Fukunaga | 2011 | World Journal of Gastrointestinal Surgery2011，3，10： | 5 |
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