Comparison of the perioperative outcomes of laparoscopic surgery, robotic surgery, open surgery, and transanal total mesorectal excision for rectal cancer: An overview of systematic reviews

Abstract

Regarding the surgical approaches for rectal cancer, many techniques have been reported in randomized controlled trials, meta‐analyses, and reviews of comparisons between two techniques, e.g. open surgery vs laparoscopic surgery, laparoscopic surgery vs robotic surgery, or laparoscopic surgery vs transanal total mesorectal excision. Since robotic surgery and transanal total mesorectal excision were developed after laparoscopic surgery had become an established minimally invasive technique, they have each been compared with laparoscopic surgery. Therefore, a review was performed to compare the surgical outcomes of robotic surgery and transanal total mesorectal excision, and to perform such comparisons among ≥3 of the above mentioned approaches, in the expectation that this review will serve as a reference for aiding treatment selection in future. The results of the current review suggest that all of the examined procedures have advantages and disadvantages, but that there are no decisive factors that could be used to select one procedure over any other. At the present time it cannot be demonstrated that laparoscopic surgery, robotic surgery, transanal total mesorectal excision, or open surgery is superior to the other techniques, and it is important to select the best technique for each patient from among those that a surgeon can perform. It is also important to maintain a flexible attitude that allows new techniques to be adopted as needed in the future.

A Novel Technique for Low Rectal Cancer: Pushing the Anus in Laparoscopic Radical Resection

“…12 It is not yet possible to prove which approach is more advantageous. 13 Some studies recommend taTME for obese male patients and low rectal cancer, 14,15 however, in some countries such as Norway, this procedure was discontinued due to a higher incidence of postoperative anastomotic leakage than nationwide, unfavorable local recurrence rates and growth patterns. 16 Bedsides, inclusion criteria regarding the distance of the tumor from the anal verge have not been standardized and taTME may cause unnecessary organ loss with very low potential morbidity and functional defects of the anastomosis.…”

A Novel Technique for Low Rectal Cancer: Pushing The Anus in Laparoscopic Radical Resection

“…In addition to the traditional laparotomy, the surgical methods mainly involve the robotic-assisted laparoscopic surgery (R-TME) [10], the laparoscopic total mesorectal excision [11], and the transanal total mesorectal excision (taTME) [12]. It is not yet possible to prove which approach is more advantageous [13]. Some studies recommend taTME for obese male patients and low rectal cancer [14,15], however, in some countries such as Norway, this procedure was discontinued due to a higher incidence of postoperative anastomotic leakage than nationwide, unfavorable local recurrence rates and growth patterns [16].…”

“…And the robotic surgery is not widely used due to the high cost and the complexity of the operation, so the laparoscopic mesorectal resection is still the main surgical method [13].…”

The Robotic Approach in Rectal Cancer

“…A recent retrospective study of 732 patients analyzing long-term oncologic outcomes using tilt score matching showed comparable survival between robotic and laparoscopic TME. In multivariate analysis, robotic surgery was a significant better prognostic factor for overall survival and cancer-specific survival [23]. The most recent and largest randomized clinical trial of laparoscopic or robotic approach for patients with rectal adenocarcinoma (ROLARR) demonstrated comparable oncological results [24].…”