TME surgery for rectal cancer remains the gold standard. A significant proportion of patients will get lateral pelvic lymph nodal metastasis. Preoperative MRI and PET scan are useful adjuncts to stratify the risk of LPLND. However there remains an east-west divide with regards to the management strategy for lateral pelvic nodes. Most European surgeons will treat them with chemoradiotherapy however in Korea & Japan, lateral pelvic node dissection is more widely performed in addition to TME for mid to low rectal cancer.
TME surgery for rectal cancer remains the gold standard. The application of laparoscopy to the management of colorectal caner is increasing, however the rates of laparoscopy in the management of rectal cancer remain low. Challenges in a true pelvis with loss of tactile feedback, difficult access and stapling pose serious challenges. There is a definitely a significant learning curve and the expert laparoscopic surgeon seem to get much better results from Lap TME than the others.
Rectal cancer surgery has its own challenges due to oncological concerns, operating in a narrow pelvis and avoiding collateral damage. Robotic platform has been increasingly used to perform TME surgery. Limited access to the robotic system, a gap in skills and training and lack of published data remain the main barriers to wider adoption of this technique, especially in a cost effective healthcare system. The benefits of using a DaVinci system include 3D vision with stable camera platform, endowrist action with enhanced access to a narrow pelvis and the robotic arms providing fixed and stable retraction.