At the 9th Annual Meeting of the Chinese Medical Doctor Association’s Colorectal Oncology Committee, Dr. Guiyu Wang from The Second Affiliated Hospital of Harbin Medical University delivered a highly anticipated presentation titled “Key Surgical Updates in the CACA Colorectal Cancer Guidelines”. His talk incorporated the latest advancements in surgical oncology, offering new perspectives on minimally invasive treatment for colorectal cancer. The guideline updates focus on surgical techniques, procedural refinements, and evolving treatment concepts, providing significant guidance for the advancement of clinical practice in colorectal cancer surgery.CME Surgery: The Standard Choice for High-Volume Centers
Radical surgery remains the cornerstone of colorectal cancer treatment, requiring both complete tumor resection with regional lymph node dissection and the preservation of organ function whenever possible. The concept of Complete Mesocolic Excision (CME) was developed based on this principle. The 2021 RELARC study, published in Lancet Oncology, provided strong evidence supporting the widespread adoption of CME. This study compared CME and D2 dissection in laparoscopic right hemicolectomy and found comparable postoperative complication rates, with 20% in the CME group (97 out of 495 patients) and 22% in the D2 group (109 out of 500 patients). Given these findings, the new CACA guidelines recommend CME as the standard surgical approach for non-metastatic right-sided colon cancer in experienced centers.
This guideline update not only reinforces CME’s oncologic superiority but also highlights its perioperative safety, ensuring its broader application in appropriate patient populations. As more surgeons refine their proficiency in CME, this approach is expected to become a preferred option for right-sided colon cancer, offering improved oncologic outcomes while maintaining high standards of surgical safety.
NOSES Surgery: A Precision Approach for Specialized Teams
With the rapid advancement of minimally invasive techniques in colorectal cancer surgery, Natural Orifice Specimen Extraction Surgery (NOSES) has gained traction due to its ability to eliminate abdominal incisions. NOSES primarily includes transvaginal specimen extraction (TVSE) and transanal specimen extraction (TASE). A 2022 study published in Science Bulletin demonstrated that NOSES offers favorable short-term surgical outcomes and excellent oncologic control.
However, the new CACA guidelines emphasize that NOSES requires a highly skilled surgical team. Surgeons must possess extensive experience in laparoscopic techniques and be proficient in performing complete intracorporeal gastrointestinal reconstruction. This guideline revision aims to ensure the safety and efficacy of NOSES in clinical practice, preventing complications associated with inadequate surgical expertise. By enforcing strict qualification criteria, the guidelines ensure that NOSES is performed by experienced teams capable of achieving optimal patient outcomes.
Robotic Surgery: Expanding Access to Advanced Techniques
Laparoscopic surgery has become a widely accepted approach for rectal cancer, offering proven safety and minimally invasive benefits. Robotic-assisted surgery, an evolution of laparoscopic techniques, further enhances surgical precision, particularly in low anterior resection and intersphincteric resection. Robotic systems have demonstrated advantages in reducing the risk of positive circumferential resection margins, which is crucial for minimizing local recurrence and distant metastasis.
A 2023 study published in the International Journal of Surgery compared the Kondor surgical robot and the Da Vinci robotic system in robot-assisted colectomy. The study found no significant difference in Clavien-Dindo grade II or higher complications (3.6% for Kondor vs. 3.3% for Da Vinci) or major adverse events (7.1% for Kondor vs. 6.7% for Da Vinci). These findings challenge the notion that robotic surgery is limited to high-end centers equipped with Da Vinci systems, paving the way for broader adoption of robotic-assisted procedures in more hospitals.
The latest guideline revisions recognize robotic surgery as a viable alternative to laparoscopic techniques, particularly for complex colorectal cancer cases. As more robotic systems become available, robotic surgery is expected to improve surgical accessibility and outcomes, enabling more patients to benefit from advanced precision techniques.
Conclusion: Pioneering a New Era in Minimally Invasive Colorectal Cancer Surgery
The updated CACA colorectal cancer surgical guidelines mark a significant step forward in refining surgical approaches for colorectal cancer. The endorsement of CME as the standard technique for right-sided colon cancer, the promotion of NOSES for specialized surgical teams, and the expanded role of robotic-assisted surgery reflect the latest advancements in minimally invasive oncology.
As surgical techniques evolve, multidisciplinary collaboration, ongoing training, and technological innovation will be critical to further optimizing colorectal cancer treatment. With a strong emphasis on precision surgery and safety, these updates are set to improve clinical outcomes, enhance patient recovery, and redefine the future of colorectal cancer surgery.
Reassessing taTME: A New Beginning After Reevaluation
Transanal total mesorectal excision (taTME) has faced challenges in clinical adoption due to its technical complexity and limited long-term follow-up data. However, the 2023 TaLaR study, published in Annals of Surgery, has provided new insights that reshape the perception of this technique. The study compared taTME with conventional laparoscopic total mesorectal excision (laTME) and found no significant differences in intraoperative complications (4.8% vs. 6.1%, difference: -1.3%, 95% CI: -4.2% to 1.7%, P=0.42), postoperative morbidity (13.4% vs. 12.1%, difference: 1.2%, 95% CI: -2.8% to 5.2%, P=0.53), or mortality rates (0.2% in both groups).
Based on these findings, the 2025 edition of the CACA guidelines has removed the statement that taTME is limited by high technical difficulty and insufficient long-term follow-up data. This revision paves the way for broader clinical adoption of taTME, giving surgeons greater flexibility in selecting the most suitable approach for rectal cancer patients. The guideline update is expected to support more personalized surgical planning, offering patients advanced treatment options with optimized outcomes.
Balancing Function Preservation and Radical Resection in Rectal Cancer Surgery
Traditional total mesorectal excision (TME) for rectal cancer often involves partial resection of Denonvilliers’ fascia (DVF), which may lead to pelvic autonomic nerve damage, resulting in postoperative urinary and sexual dysfunction. A 2023 study on PUF-01, published in Nature Communications, has introduced a new perspective on nerve preservation in rectal cancer surgery. The study compared laparoscopic TME with DVF preservation versus TME with partial DVF resection and found no significant differences in three-year overall survival, disease-free survival, or recurrence rates.
Inspired by these findings, the updated CACA guidelines emphasize a new surgical principle: while ensuring complete tumor resection and regional lymph node clearance, surgeons should prioritize the preservation of the anal sphincter, urinary function, and sexual function whenever possible. This shift marks a significant step toward balancing oncologic radicality with organ function preservation, ultimately reducing surgical trauma and enhancing patients’ postoperative quality of life.
This update reflects the growing integration of patient-centered care into colorectal cancer treatment. By acknowledging the importance of functional outcomes alongside oncologic efficacy, rectal cancer surgery is evolving toward a more holistic and patient-friendly approach. The incorporation of these principles into clinical guidelines signifies the beginning of a new era in rectal cancer treatment, where enhanced surgical techniques align with the broader goal of improving long-term patient well-being.
Conclusion: Advancing Minimally Invasive and Precision Surgery in Colorectal Cancer
The latest updates in the CACA colorectal cancer surgical guidelines represent a comprehensive synthesis of recent advancements in minimally invasive and functional-preserving surgical techniques. The endorsement of CME as the standard approach for right-sided colon cancer, the broader acceptance of NOSES, the expansion of robotic-assisted surgery, the reassessment of taTME, and the emphasis on functional preservation in rectal cancer surgery collectively reflect the rapid progress in surgical oncology.
These refinements offer clinicians a more precise and scientifically validated framework for decision-making, ensuring that colorectal cancer treatment is not only oncologically effective but also minimally invasive and functionally preserving. As clinical practice evolves, these updates are expected to propel minimally invasive colorectal cancer surgery to new heights, bringing better survival outcomes and improved quality of life for patients worldwide.
Expert Profile: Dr. Guiyu Wang
Affiliation: The Second Affiliated Hospital of Harbin Medical University Position: Director of the Oncology Center, Chief of Colorectal Surgery
Professor Wang holds multiple leadership roles in national oncology committees, including:
- Vice Chair, Colorectal Cancer Committee, Chinese Anti-Cancer Association (CACA)
- Vice Chair, NOSES Committee, Chinese Anti-Cancer Association
- Standing Member, Colorectal Oncology Physician Committee, Chinese Medical Doctor Association
- Committee Member, Colorectal Cancer Group, Chinese Society of Clinical Oncology (CSCO)
- Chair, Minimally Invasive and Anatomy Group, Colorectal Oncology Physician Committee, Chinese Medical Doctor Association
- Vice Chair, Integrated Oncology Committee, Chinese Medical Doctor Association’s Integrated Medicine Branch
