Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer: a retrospective propensity score-matched cohort study of short-term outcomes

Abstract

Background Laparoscopic total mesorectal excision (TME) surgery for rectal cancer has important technical limitations. Robot-assisted and transanal TME (TaTME) may overcome these limitations, potentially leading to lower conversion rates and reduced morbidity. However, comparative data between the three approaches are lacking. The aim of this study was to compare short-term outcomes for laparoscopic TME, robot-assisted TME and TaTME in expert centres. Methods Patients undergoing rectal cancer surgery between 2015 and 2017 in expert centres for laparoscopic, robot-assisted or TaTME were included. Outcomes for TME surgery performed by the specialized technique in the expert centres were compared after propensity score matching. The primary outcome was conversion rate. Secondary outcomes were morbidity and pathological outcomes. Results A total of 1078 patients were included. In rectal cancer surgery in general, the overall rate of primary anastomosis was 39.4, 61.9 and 61.9 per cent in laparoscopic, robot-assisted and TaTME centres respectively (P < 0.001). For specialized techniques in expert centres excluding abdominoperineal resection (APR), the rate of primary anastomosis was 66.7 per cent in laparoscopic, 89.8 per cent in robot-assisted and 84.3 per cent in TaTME (P < 0.001). Conversion rates were 3.7 , 4.6 and 1.9 per cent in laparoscopic, robot-assisted and TaTME respectively (P = 0.134). The number of incomplete specimens, circumferential resection margin involvement rate and morbidity rates did not differ. Conclusion In the minimally invasive treatment of rectal cancer more primary anastomoses are created in robotic and TaTME expert centres.

Implementation of robotic rectal cancer surgery: a cross-sectional nationwide study

“…In literature, there are few reports on the tendency to create an anastomosis in robotic and laparoscopic rectal resection. A recent report shows a higher rate of primary anastomosis in RR compared to LRR in robotic expert centers, but this could not be confirmed in this paper including a multivariable analysis, which was not performed in the recent study [33]. Defunctioning stomas were more common in the robotic group, compared to the laparoscopic approach.…”

“…The 90-day morbidity rate was higher after RR compared to LRR [42% (39-45) versus 34% (33)(34)(35)(36)] while reintervention rate was similar [17% (15)(16)(17)(18)(19) versus 16% (14)(15)(16)(17)]. Specific complication were shown in Table 5.…”

“…The outcomes In patients with low tumors < 5 cm from the anal verge who underwent a low anterior resection, the proportion of patients with an anastomosis was 61% (55-68) in the robotic and 64% (61-69) laparoscopic group. Defunctioning ileostomies were created in 58% (50-67) of the robotic cases and 33% (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) of the laparoscopic cases with an anastomosis. The anastomotic leak rate was 23% (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) in the robotic group and 21% (16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in the laparoscopic group.…”

“…Over the three studied years in the robotic cases a lower percentage of anastomoses were created, the use of defunctioning ileostomies declined drastically from 50 (43-56) to 28% (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), and the anastomotic leakage rate remained stable (Table 4). For the laparoscopic resections the anastomosis rate and anastomotic leakage rate was similar over the study period.…”

Local recurrence of robot-assisted total mesorectal excision: a multicentre cohort study evaluating the initial cases

“…Up to now no clear benefits regarding post-operative morbidity have been shown [9][10][11]. However, in patients operated by experienced surgeons, the rate of primary anastomosis is suggested to be higher [12,13]. Additionally, oncological outcomes are suggested to be equal between L-TME and R-TME [14].…”