Robot-assisted laparoscopic surgery beyond total mesorectal excision for rectal cancer

Rectal surgery is the standard treatment for patients with non-metastatic rectal cancer. Expert surgery, which includes total mesorectal excision (TME) (1), is of crucial importance for mid-rectal and low rectal cancer patients in that it provides complete removal of the tumor-bearing rectum and its associated lymph nodes within the mesorectum and thus minimizes the risk of resection margin positivity and local recurrence. However, patients with advanced low rectal cancer occasionally develop metastases to the lateral pelvic lymph nodes like common iliac, internal iliac, external iliac, and obturator nodes, which are located outside the surgical field of TME (2,3). Additional treatment is therefore often required to reduce local recurrence.