LAUSR

In 2006, the Cochrane Review [1] had identified 48 articles describing laparoscopic resection for rectal cancer, although only three of those studies were randomized controlled trials (RCTs) accounting for over 600 patients. These RCTs did not comply with the CONSORT statement [2] on allocation concealment. Two of the trials provided no data on the distance of the cancer from the anal verge [3, 4]; hence, it is possible that these trials included rectosigmoid cancers. The CLASICC RCT [5] provided the only credible source of truly randomized data on laparoscopic resection for rectal cancer at that time. Although not reaching statistical significance (p = 0.19), the involvement of the circumferential resection margin (CRM) was doubled in the laparoscopic arm as compared to its open counterpart, 12 versus 6%. In the following years, four non-inferiority RCTs comparing laparoscopic to open resection for rectal cancer were launched with the following composite endpoints: CRM, distal margin, total mesorectal excision (TME) quality, local recurrence and 3-year survival. Our aim was to review the rationale for not supporting laparoscopic surgery for rectal cancer, and the data comparing cancer-related metrics. The topic was limited to oncological outcomes of proctectomy for rectal cancer. This paper does not offer a comprehensive review of the subject, but rather a concise overview of the evidence available in the English language literature, highlighting some issues relevant to shortand long-term oncological outcomes.