**5. Conclusions**

Surgical resection is a crucial milestone in the multimodal treatment of rectal cancer. A proper and accurate TME represents the most important factor for the postoperative oncological outcome. With the development of minimally invasive techniques in general surgery, the open approach to rectal cancer surgery has been progressively abandoned. More recently, the robotic surgical platform has gained consent in the surgical community. In addition to the well-known advantages of the robotic system over laparoscopy in terms of surgeon's comfort and 3-D visualization, robotic-assisted rectal resection can overcome technical difficulties related to anatomical conditions, such as a narrow pelvis in males and obese patients. Moreover, a learning curve for robotic TME is shorter than for laparoscopic TME. When experienced surgeons perform robotic rectal surgery, the actual operating times do not significantly exceed the laparoscopic ones. Advantages of the robotic technique are counterbalanced by still-elevated costs that hamper its diffusion in surgical centers. No difference in terms of oncological outcomes is reported in the two different minimally invasive approaches.

Different surgical procedures can be offered to the patient affected by rectal cancer, according to its distance from the anal verge and its local extension. The most frequent procedure is low anterior resection. When feasible, a sphincterpreserving procedure should be preferred, and only in case of sphincter involvement or unachievable negative resection margins, abdomino-perineal resection with

permanent colonostomy be performed. Different sphincter-preserving techniques have been described, and intersphincteric resection can offer the maintenance of fecal continence. In recent years, transanal TME has been developed, to reduce surgical trauma and improve postoperative results for patients. In this chapter, the currently available options in rectal surgery are reported and the robotic techniques are explained in detail.
