Advances in beyond total mesorectal excision surgery: Behind the scenes

Abstract

The management of locally advanced rectal cancer involving adjacent organs and extending beyond the surgical planes of total mesorectal excision has evolved over the past few decades both in terms of the effectiveness of preoperative treatments and surgical innovation. The use of a robotic platform is increasing, even in complex surgery such as pelvic exenteration together with the advantages of minimally invasive procedures. However, satisfactory surgical, oncological, and functional outcomes are achieved not only minimizing the impact of a demolitive surgery but also when a multidisciplinary specialized team focuses on experienced surgeons, mandatory rules of surgical oncology, appropriate medical treatments, accurate preoperative planning, and an acceptable quality of life.

Keywords: Robotic surgery; Locally advanced rectal cancer; Pelvic exenteration; T4; Multivisceral resection

Core Tip: A minimally invasive robotic approach is a promising alternative to open procedures in rectal cancers requiring beyond total mesorectal excision surgery. Combined with specialists and resources, the contemporary management of advanced rectal cancer scheduled for pelvic exenterations requires a structured surgical management based on shared decision-making.