J.Jpn. Surg. Soc.. 116(5): 297-301, 2015

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Feature topic

CURRENT STATUS OF AND OUTLOOK FOR THE LATEST MINIMALLY INVASIVE SURGERY FOR COLORECTAL DISEASES

Randomized clinical trials (RCTs) comparing laparoscopic surgery (LS) with open surgery (OS) in patients with colon cancer showed no statistical differences in, safety, and long-term outcomes. LS for colon cancer has become a standard procedure. LS for rectal cancer has also shown advantages, although RCTs showed no significant differences between groups in the long-term outcome. The magnification of laparoscopy enables surgeons to operate precisely in the narrow pelvis while sparing the autonomic nerves and nerves to the anal sphincter. Good visualization of the pelvis offers better education and will likely be used more frequently for rectal cancer. Invasion of rectal cancer to other organs and massive tumors are, however, technically demanding. The younger generation is more susceptible to Crohn's disease and inflammatory bowel disease (IBD), and high recurrence rates mean more reoperations. Esthetic outcomes and minimal adhesion maximize the advantages of LS in treating Crohn's disease and IBD. Total proctocolectomy LS for IBD and ulcerative colitis is safe and minimally invasive. However, LS may take longer than OS, and emergencies such as toxic megacolon and massive hemorrhage remain contraindications. Ongoing clinical trials should reveal the feasibility of these new LS procedures in robotic and single-port surgery.

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