LAPAROSCOPIC MANAGEMENT OF RECTAL CANCER

Francis Seow-Choen

Medical Director and Senior Consultant

Seow-Choen Colorectal Centre

Singapore

Rectal cancers were initially treated in the 1880’s by tearing out with the surgeon’s hands. It took more than a 100 years for precise sharp dissection to come into vogue. This only happened with the advent of a better understanding of the mesorectum and of the importance of total mesorectal excision. Similarly, the understanding of the importance of laparoscopic techniques took many decades. The early pioneers of laparoscopic surgery were ridiculed, criticized and even formally investigated and charged for malpractice. In a survey in the mid 1990’s only 6% of surgeons said they wanted a laparoscopic approach if they were to have rectal cancer. However, by the mid 2000’s laparoscopic colorectal resection became more acceptable worldwide. Over the last 20 or so years, laparoscopic rectal resection has become gradually the gold standard for surgical removal of rectal cancers. But there is not just one technique for laparoscopic rectal cancers. Laparoscopy can be hybridized with robotic techniques, as well as transanal techniques to ensure better surgery. Laparoscopy itself may be through multiports, reduced ports or even single ports. Specimens may be removed via a separate incision, the umbilicus or even through other natural orifices. The present decade is a decade of unprecedented innovation and technological advances. Laparoscopic surgery for rectal cancers is not a dying science. Laparoscopic rectal cancer surgery is here to stay. It will further advance and develop in order that surgeons can better use it to help even more patients.