New technology-based innovation changes surgical practice and research direction in solid cancers

Without innovation, no progress can be achieved. To improve oncological outcomes and the quality of life (QOL) of patients with rectal cancer and other solid tumors, we should change both surgical and adjuvant treatment. For improving survival and cure rates, more efficient surgery and novel combinations of chemotherapeutic and targeted agents are needed. Moreover, we need new markers for identifying individual responder patients to specific drug combinations. In the field of day-to-day surgical practice, the next generation of the robotic da Vinci surgical system, and in the field of biomarkers and next-generation targeted agents, the latest high-throughput technologies provide exciting scientific promise for the future. Over the coming decade, next-generation DNA sequencing technology for understanding cancer’s origin, progression, and metastasis [1, 2] and a new generation of the da Vinci surgical robotic system for clinical practice [3] are fundamental for changing the management of solid cancers, including rectal cancer. Dramatic progress has been made in the surgical treatment of low rectal cancer. A safe and effective sphincterpreserving procedure resulting in complete resection of the primary tumor and regional lymph nodes (R0) resection has been established as the standard of care. This optimal low anterior resection includes total mesorectal excision (TME), a safety zone from the tumor of at least 2 cm, and high inferior mesenteric ligation with splenic flexure mobilization. This standard open low anterior resection has recently been adopted into laparoscopic surgery with the substantial benefits of a minimally invasive approach. It should be emphasized that according to evidence-based principles in biomedical science, results from comparativeeffectiveness research from phase III randomized trials