Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Artif Intell Gastroenterol. Dec 8, 2023; 4(3): 64-71
Published online Dec 8, 2023. doi: 10.35712/aig.v4.i3.64
Use of artificial intelligence in total mesorectal excision in rectal cancer surgery: State of the art and perspectives
Vinicio Mosca, Giacomo Fuschillo, Guido Sciaudone, Kapil Sahnan, Francesco Selvaggi, Gianluca Pellino
Vinicio Mosca, Giacomo Fuschillo, Francesco Selvaggi, Gianluca Pellino, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Napoli 80138, Italy
Guido Sciaudone, Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso 86100, Italy
Kapil Sahnan, Department of Colorectal Surgery, St Mark’s Hospital, London HA1 3UJ, United Kingdom
Kapil Sahnan, Department of Surgery and Cancer, Imperial College London, London SW7 5NH, United Kingdom
Gianluca Pellino, Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona 08035, Spain
Author contributions: Mosca V and Pellino G conceived and presented the idea; Mosca V and Fuschillo G wrote the manuscript with the support of Sahnan K and Pellino G; Sciaudone G, Sahnan K, and Selvaggi F supervised the results of this work; Pellino G oversaw the process and was responsible for the overall planning and management; All authors discussed the results and contributed to the final manuscript.
Conflict-of-interest statement: Dr. Pellino has nothing to disclose. The other authors make no declarations regarding their potential conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Gianluca Pellino, FACS, FASCRS, FEBS, FRCP, FRCS (Gen Surg), MD, PhD, Associate Professor, Surgeon, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Policlinico CS, Piazza Miraglia 2, Napoli 80138, Italy.
Received: July 27, 2023
Peer-review started: July 27, 2023
First decision: August 31, 2023
Revised: September 13, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: December 8, 2023

Colorectal cancer is a major public health problem, with 1.9 million new cases and 953000 deaths worldwide in 2020. Total mesorectal excision (TME) is the standard of care for the treatment of rectal cancer and is crucial to prevent local recurrence, but it is a technically challenging surgery. The use of artificial intelligence (AI) could help improve the performance and safety of TME surgery.


To review the literature on the use of AI and machine learning in rectal surgery and potential future developments.


Online scientific databases were searched for articles on the use of AI in rectal cancer surgery between 2020 and 2023.


The literature search yielded 876 results, and only 13 studies were selected for review. The use of AI in rectal cancer surgery and specifically in TME is a rapidly evolving field. There are a number of different AI algorithms that have been developed for use in TME, including algorithms for instrument detection, anatomical structure identification, and image-guided navigation systems.


AI has the potential to revolutionize TME surgery by providing real-time surgical guidance, preventing complications, and improving training. However, further research is needed to fully understand the benefits and risks of AI in TME surgery.

Keywords: Artificial intelligence, Machine learning, Rectal cancer, Total mesorectal excision, Colorectal surgery

Core Tip: This review provided an overview of the current use of artificial intelligence methods in surgery and the latest findings on their use during total mesorectal excision dissection in rectal cancer procedures. It also discussed the main limitations of artificial intelligence in surgery and that it is still not used in clinical settings.