2017 Volume 63 Issue 5 Pages 384-392
Laparoscopic colectomy was first used for the treatment of colorectal cancer early in the 1990s, before spreading rapidly throughout the world. In comparison with open surgery, laparoscopic colectomy has the advantages of smaller incision, less pain, and faster recovery during the early postoperative period. Randomized controlled trials (RCTs) have compared it with open surgery, demonstrating similarities in terms of postoperative complications and long-term prognosis.
Endoscopic submucosal dissection (ESD) allows the dissection of relatively large tumors en bloc. Japanese national health insurance began to cover the procedure in 2012 for the treatment of intramucosal carcinoma (Tis) or carcinoma with slight submucosal invasion (T1a) in colorectal cancer. The clinical introduction of this procedure enabled radial treatment of early colorectal cancer (Tis/T1a). Furthermore, robotic surgery, the latest means of treatment for cancer, began to be covered by insurance in 2014 for the treatment of prostate cancer. At present, robotic surgery for colorectal cancer is not covered by insurance, and is carried out in the context of clinical trials with limited institutions. Robotic surgery enables precise surgery, and is likely to offer minimally invasive surgery for cases of rectal cancer in which it is especially important to preserve urinary and sexual function in the narrow pelvic space.
Over the past two decades, treatment of colorectal cancer has advanced rapidly. Endoscopic treatment, laparoscopic surgery, and robotic surgery now play an important role in minimally invasive treatment options for colorectal cancer and are expected to show further advances in the future.