Colorectal cancer is one of the most common gastrointestinal tumors, ranking 4th in incidence among men and 3rd in incidence among women, and its incidence and death rate are still on the rise. In recent years, surgical oncology has followed the principles of minimizing the scope of surgery, reducing trauma and preserving the function to the greatest extent without compromising the efficacy. Minimally invasive surgery and transplantation surgery are the mainstream of development in the 21st century, and minimally invasive surgery is one of the hot spots in surgical oncology treatment. In 1992, Kockerling successfully used laparoscopy for the first time to complete the first case of radical rectal cancer, and in 1993, Minhua Zheng and others completed the first laparoscopic radical surgery for sigmoid colon cancer in China. At that time, there were certain controversies about the use of laparoscopy for the treatment of colorectal cancer, such as the safety of laparoscopy and the metastasis of tumor cell implantation caused by pneumoperitoneum. After more than 20 years of development, the feasibility, safety, curative effect and near and long-term efficacy of laparoscopic surgery for colorectal malignant tumors have been confirmed by more and more clinical studies, and the surgical technique has been improved and developed in practice and promotion. 2005 American clinical guidelines for rectal cancer treatment clearly pointed out that rectal resection by laparoscopic technique has been established and is feasible. The Laparoscopic and Endoscopic Surgery Group of the Chinese Medical Association’s Surgery Branch and the Laparoscopic Surgery Group of the Chinese Anti-Cancer Association’s Colorectal Cancer Specialty Committee jointly formulated the Guidelines for Laparoscopic Radical Colorectal Cancer Surgery in 2006 and revised them in 2008. The Ministry of Health also affirmed the status of laparoscopic radical colorectal cancer surgery in the Specification for Colorectal Cancer Treatment (2010 Edition). Through more than twenty years of applied research, laparoscopic radical colorectal cancer. I. Radicality and long-term efficacy of surgery It is generally believed that the resection of lesions and lymph node clearance are the main factors of whether the surgery for colorectal cancer is radical or not. In a prospective randomized clinical study by Lacy et al, it was found that in patients with stage I and II colorectal cancer, the laparoscopic surgery group was more effective than the traditional open surgery group in terms of near and long-term outcomes. In late 2007, the results of a multicenter RCT on the long-term outcome of laparoscopic versus open colorectal cancer surgery were published by the CLASICC study group in the United Kingdom: the subgroup of rectal cancer included 253 patients in the laparoscopic group and 128 patients in the open group. group and 128 patients in the open group. The positive margin rate and number of lymph nodes were similar in both groups; the rate of positive circumferential margins was slightly higher in patients who underwent laparoscopic low anterior resection, but the difference did not reach statistical significance; operative mortality, complication rates, and quality-of-life scores were also similar in both groups. Updated data from this trial over the subsequent 3 years showed comparable oncologic and long-term quality of life outcomes in the laparoscopic and open groups. el-Gazzaz et al. reported the results of a randomized controlled trial of 729 cases (243 in the laparoscopic group and 486 in the open group) and found no statistically significant difference in the number of lymph nodes obtained with laparoscopic surgery compared with open surgery. The above findings suggest that laparoscopic colon cancer surgery can achieve similar long-term outcomes as conventional open surgery, and some data even suggest better long-term outcomes for laparoscopic colon cancer. What is TME? Total mesorectalexcision (TME) is also called perirectal mesorectal excision. Previously, it was thought that the rectum had no mesentery, but subsequent studies have found that the rectal mesentery exists. The rectal mesentery is a structure containing arteries, veins, lymphatic tissues and connective tissues in the lateral posterior wall of the rectum wrapped by a dirty layer of fascia, which is posteriorly adjacent to the rectosacral fascia (Waldeyer’s fascia), with a distinctly sparse gap. heald first proposed total rectal mesenteric resection in 1980, but it was not taken seriously at that time. With the development of more clinical practice, TME was proven to be safe and feasible and gradually accepted. TME is actually the removal of the lymph nodes at the first station, which makes the recurrence rate of rectal cancer tumor with anal preservation surgery greatly reduced. tME can be considered as a milestone in the treatment of rectal cancer. Compared with open surgery, because laparoscopy can reach the narrow small pelvis and magnify the local view to clearly reveal the anatomical level of the presacral area, the judgment of the loose tissue gap between the two layers of the pelvic fascial wall and the choice of access are more accurate; and the application of ultrasonic knife along the pelvic fascial gap for sharp dissection can more completely remove the rectal mesentery containing the dirty pelvic fascial layer, i.e. to ensure the integrity of the rectal mesentery to the greatest extent. These advantages are often lacking in conventional open low rectal surgery. With the aid of these advantages, the surgeon is better able to perform TME and comply with the principles of radical tumor cure for rectal cancer surgery. Third, the issue of anus preservation It is the obligation of every surgeon to improve the postoperative quality of life of patients with low rectal cancer while ensuring radical tumor cure. The treatment of low rectal cancer has developed from the previous standard of removing tumor and improving long-term survival rate to the current standard of preserving complete anal function on the basis of ensuring radical tumor treatment. The mode of tumor infiltration and metastasis largely determines whether patients with low rectal cancer can receive anus-preserving surgery. Studies have confirmed that longitudinal metastasis of rectal cancer along the intestinal canal rarely exceeds 2 cm, and for patients with ultra-low rectal cancer at DukeA to DukeC stages, the length of the intestinal canal at the lower incision margin of 2 cm is sufficient and does not affect the recurrence rate of the tumor or the survival rate of patients. Hideki et al. in Japan even suggested that 1 cm of resection of the distal intestinal canal is sufficient for well-differentiated tumors. For patients with ultra-low rectal cancer (the lower border of tumor is 4-6 cm from the anal verge), they can often undergo myectomy (anal resection and abdominal wall fistula). The local magnification of laparoscopy and fine instruments can easily separate to the low pelvic level, which gives hope to patients who cannot preserve anus with traditional surgery. IV. Effects on stress reaction and organism immunity Surgical blows can affect the immune function of the organism after surgery, and the size of surgical trauma seems to be closely related to the degree of immune function affected. Laparoscopic surgery is not only minimally invasive, but also reduces the impact on the immune function of the organism. By comparing the analysis of peripheral blood endothelin (ET), nitric oxide (NO), serum interleukin-6 (IL-6) and C-reactive protein (cRP) in patients before and after laparoscopic and open colon cancer surgery, Li Yongshuang et al. found that the stress response in the laparoscopic surgery group was significantly lower than that in the open surgery group. Minimal impairment of immunity allowed for maximum protection of one’s own anti-tumor capacity, while patients were able to recover quickly, providing the possibility of early initiation of comprehensive treatment such as chemotherapy. This is of great significance for tumor patients. V. Minimally invasive Laparoscopic colorectal cancer surgery is minimally invasive in terms of small incision, less bleeding and less tissue harassment. Using the exact hemostasis effect during sharp separation of ultrasonic knife, the accurate focus of energy, and the operating characteristics of unobstructed penetration into the limited space of the pelvis, it not only ensures a clean operative field, but also avoids blind dissection and thermal damage to surrounding tissues, and minimizes the degree of impact of surgery on urogenital function. A study by J. Xia et al. showed that the laparoscopic group was superior to the open group in terms of incision length, intraoperative bleeding, postoperative hospital stay, and anal venting time. Rapid recovery of postoperative gastrointestinal function is one of the main advantages of laparoscopic surgery. After laparoscopic rectal cancer surgery, patients generally recovered their gastrointestinal function in 3-5 days, and gradually resumed normal diet in 3-6 days after surgery, and the hospitalization time and resumption of feeding time were significantly better than those of open surgery. In 210 patients with laparoscopic and open intersphincteric resection for rectal cancer reported by Park et al, the mean postoperative venting time was 2.6 days and 3.2 days, respectively, and the median postoperative venting time was 38.5 h and 60 h for laparoscopic and open after neoadjuvant treatment, and the median time to return to normal diet was 85 h and 93 h, respectively, and both laparoscopic groups were superior to open groups. In conclusion, at present, colorectal cancer surgery belongs to the era of minimally invasive surgery, and laparoscopic colorectal cancer surgery is the mainstream of current minimally invasive surgery, and minimally invasive surgery has entered the era of new technologies such as robotic surgery, single-hole laparoscopy and natural lumen endoscopic surgery. At present, the rapid development of science and technology, 3-D technology, various imaging systems, micro devices and digital information technology have made laparoscopic equipment and technology increasingly improved, and the safety, convenience, minimally invasive and aesthetic features of laparoscopic surgery will be further improved.