Key points of tumor-free operation in laparoscopic resection for colorectal cancer

Tumor-free operation is an important principle of oncological surgery for colorectal cancer. Laparoscopic resection of colorectal cancer should also adhere to the tumor-free operation principle. Iatrogenic dissemination of cancer cells into the abdominal cavity during the laparoscopic resection of colorectal cancer is possible and should be paid attention by the surgeons. In order to reduce the rate of peritoneal seeding, the tumor-free operation principle should be implemented throughout the whole laparoscopic procedure. The steps we should follow as a routine practice include: (I) proper management of trocars and the pneumoperitoneum; (II) no-touch and protection of the tumor; (III) protection of the incision wound; (IV) priority of the high vascular ligation; (V) en bloc resection of the primary tumor and regional lymph nodes; (VI) sharp resection of the tumor; (VII) complete mesocolic excision (CME) of colon cancer and total mesorectal excision (TME) of rectal cancer; (VIII) replacement of the surgical instrument and gloves after the removal of the tumor; (IX) satisfactory scrub and irrigation; and (X) selective intraperitoneal chemotherapy.