Is it time for a paradigm shift: “laparoscopy is now the best approach for rectal cancer”?

Laparoscopic approach for colon cancer surgical management has now clearly demonstrated its short-term advantages over the open approach with similar long-term oncological outcomes. On the other hand, rectal cancer surgery is a more technically demanding procedure and the safety and efficacy of laparoscopic approach for such surgery was initially questioned. The CLASICC trial, published in 2005, was the first randomized controlled trial to report results of laparoscopic total mesorectal excision (TME) for cancer and initially suggested a high risk of conversion, associated with a high risk of postoperative morbidity and incomplete resection. Since, the COREAN trial and, more recently, the COLOR II studies reported excellent results of laparoscopic TME with low risk of conversion and improved short-term results as compared to the open approach, although no long-term data is available to date. However, the discrepancies observed between the results of early and recent studies might highlight the importance of the learning curve in laparoscopic rectal surgery, which might jeopardize both short-term and oncological outcomes.