Laparoscopic surgery of rectal cancer has experienced more than 20 years of technical development and clinical research. Based on the published high-level clinical trials such as COREAN, COLOR Ⅱ, ACOSOG Z6051 and ALacaRT, laparoscopic surgery is recommended as method to treat rectal cancer by the NCCN Clinical Practice Guideline on Rectal Cancer (version 1.2016) with class 2A evidence. But it is also suggested that the surgeons should have experiences of performing minimally invasive proctectomy with total mesorectal excision. It is not recommended for the cases of locally advanced disease with a threatened or high risk circumferential resection margin based on staging. For those patients with high risk tumors, open surgery is preferred. Further analysis of the clinical trials has shown that surgical technique and circumferential resection margin are the key factors that affect the outcomes of laparoscopic rectal cancer surgery. Therefore, the wide application of laparoscopic surgery in the treatment of rectal cancer still needs more evidence-based clinical trials to test and prove.
腹腔镜直肠癌手术已经历20余年历程，在COREAN、COLOR Ⅱ、ACOSOG Z6051、ALacaRT等高水平临床研究基础上，2016年NCCN《直肠癌临床实践指南》以2A类证据推荐直肠癌可以选择腹腔镜手术，同时提出，术者具有腹腔镜全直肠系膜切除术经验是前提条件；对于环周切缘存在阳性风险的患者，建议优先选择开腹手术。分析上述临床研究可以发现，外科医师手术技术及肿瘤环周切缘情况是影响腹腔镜直肠癌手术治疗效果的关键。腹腔镜手术广泛用于治疗直肠癌，仍需更多的循证医学证据支持。