A Multicenter Matched Comparison of Transanal and Robotic Total Mesorectal Excision for Mid and Low-rectal Adenocarcinoma

Abstract

High-quality TME for patients with rectal adenocarcinoma of the mid and low rectum can be equally achieved by transanal or robotic approaches in skilled hands, but attention should be paid to the distal margin.

Systemic review and network meta‐analysis comparing minimal surgical techniques for rectal cancer: quality of total mesorectum excision, pathological, surgical, and oncological outcomes

“…After removing duplicates, 739 publications were further reviewed. Further screening found that 23 studies [15][16][17][18][19][20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36]47,48 met the predefined inclusion criteria. The selection process is reported in Figure 2.…”

“…Among the included studies, eight were prospective, 24,25,28,29,32,34,35,48 and 15 retrospective. [15][16][17][18][19][20][21][22]26,27,30,31,33,36,47 F I G U R E 1 Network geometry for studies reporting A, complete mesorectum excision; B, near complete mesorectum excision; C, incomplete mesorectum; D, radial margin involvement; E, lymph node harvest; F, local recurrence; G, distal recurrence; H, overall complication rate; I, anastomotic leak; L, wound infection; M, urinary dysfunction; N, bowel obstruction; O, reoperation; and P, 30-day mortality. lapTME, laparoscopic TME; roTME, robotic-assisted TME; taTME, transanal TME; TME, total mesorectal excision…”

Transanal TME: new standard or fad?

“…According to a recent paper in the study by Lee et al comparing the outcomes of robotic and taTME for mid-and low-rectal cancer (! 10 cm from the anal verge) using coarsened exact matching, short-term postoperative outcomes and pathological outcomes were closely comparable ( Table 2) 59) . It should be noted that distal margin tumor involvement was observed more frequently in the taTME group (1.8% vs. 0.3%; P = 0.051) as opposed to the robotic group, despite the longer length to distal margin (16.9 mm vs. 15.1 mm; P = 0.097).…”

“…Several retrospective studies comparing robotic surgery and taTME for rectal cancer have revealed that they are equivalent as per short-term outcomes and/or histopathological outcomes 59,60) . According to a recent paper in the study by Lee et al comparing the outcomes of robotic and taTME for mid-and low-rectal cancer (!…”

Is robotic rectal resection the preferred option for resectable cancer?

“…Proponents of taTME believe that this is the best approach for rectal dissection, as this technique offers great access to distal 1/3 rectal dissection, a good view of the pelvic anatomy, the ability to define the distal resection margin and potential for double purse-string anastomosis. A multicentre study comparing robotic TME to taTME has found that high quality TME can be achieved by both robotic and transanal approaches in skilled hands [45] . However, long term data on oncological and functional outcomes of taTME are yet to be established.…”