Meta-analysis of the impact of surgical approach on the grade of mesorectal excision in rectal cancer

Creavin, Ben; Kelly, Michael E.; Ryan, Éanna J; Winter, Desmond C.

doi:10.1002/bjs.10664

Cited by 43 publications

(25 citation statements)

References 44 publications

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“…Further analysis confirmed the absence of difference at 5 years [30]. A recent meta-analysis has demonstrated only small differences between the two approaches in terms of the quality of mesorectal excision [31]. In our study, the differences detected in the completeness of the excised mesorectum are consistent with those observed in locoregional recurrence rates at 2 years.…”

Section: Discussionsupporting

confidence: 90%

A propensity‐score‐matched analysis of laparoscopic vs open surgery for rectal cancer in a population‐based study

et al. 2019

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Aim The oncological risk/benefit trade‐off for laparoscopy in rectal cancer is controversial. Our aim was to compare laparoscopic vs open surgery for resection of rectal cancer, using unselected data from the public healthcare system of Catalonia (Spain). Methods This was a multicentre retrospective cohort study of all patients who had surgery with curative intent for primary rectal cancer at Catalonian public hospitals from 2011 to 2012. We obtained follow‐up data for up to 5 years. To minimize the differences between the two groups, we performed propensity score matching on baseline patient characteristics. We used multivariate Cox proportional hazards regression analyses to assess locoregional relapse at 2 years and death at 2 and 5 years. Results Of 1513 patients with Stage I–III rectal cancer, 933 (61.7%) had laparoscopy (conversion rate 13.2%). After applying our propensity score matching strategy (2:1), 842 laparoscopy patients were matched to 517 open surgery patients. Multivariate Cox analysis of death at 2 years [hazard ratio (HR) 0.65, 95% CI 0.48, 0.87; P = 0.004] and 5 years (HR 0.61, 95% CI 0.5, 0.75; P < 0.001) and of local relapse at 2 years (HR 0.44, 95% CI 0.27, 0.72; P = 0.001) showed laparoscopy to be an independent protective factor compared with open surgery. Conclusions Laparoscopy results in lower locoregional relapse and long‐term mortality in rectal cancer in unselected patients with all‐risk groups included. Studies using long‐term follow‐up of cohorts and unselected data can provide information on clinically relevant outcomes to supplement randomized controlled trials.

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Section: Discussionsupporting

confidence: 90%

A propensity‐score‐matched analysis of laparoscopic vs open surgery for rectal cancer in a population‐based study

et al. 2019

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“…However, there have been concerns over the quality of TME in minimally invasive techniques . Despite this, to date this has not translated into an effect on oncological outcomes …”

Section: Introductionmentioning

confidence: 99%

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

Rausa

Bianco

Kelly

et al. 2019

Journal of Surgical Oncology

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Background Minimal invasive surgery has revolutionized recovery in rectal cancer patients. However, there has been debate on its effect on quality of total mesorectal excision (TME) and oncological outcomes. This network meta‐analysis compares laparoscopic, robotic‐assisted, and transanal TMEs. This study shows that All three surgical techniques are comparable across TME quality and oncological outcomes. Ultimately, good outcomes are based on each individual surgeon choosing an approach based on their expertise.

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“…3). 55,56 While measuring distances within the bony pelvis gives an impression of access to the pelvic floor, many other factors contribute to reducing the working space, like size of the tumor, volume of the mesorectum, and size of the prostate in male patients. Other factors that contribute to an increasing level of difficulty of low pelvic dissection are high body mass index, time interval after radiotherapy, anterior location of the tumor, and distance between lower border of the tumor and anorectal junction (►Fig.…”

Section: Beyond Tmementioning

confidence: 99%

Total Mesorectal Excision Technique—Past, Present, and Future

Knol

Keller

2020

Clinics in Colon and Rectal Surgery

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While the treatment of rectal cancer is multimodal, above all, a proper oncological resection is critical. The surgical management of rectal cancer has substantially evolved over the past 100 years, and continues to progress as we seek the best treatment. Rectal cancer was historically an unsurvivable disease, with poor understanding of the embryological planes, lymphatic drainage, and lack of standardized technique. Major improvements in recurrence, survival, and quality of life have resulted from advances in preoperative staging, pathologic assessment, the development and timing of multimodal therapies, and surgical technique. The most significant contribution in advancing rectal cancer care may be the standardization and widespread implementation of total mesorectal excision (TME). The TME, popularized by Professor Heald in the early 1980s as a sharp, meticulous dissection of the tumor and mesorectum with all associated lymph nodes through the avascular embryologic plane, has shown universal reproducible reductions in local recurrence and improvement in disease-free and overall survival. Widespread education and training of surgeons worldwide in the TME have significantly impact outcomes for rectal cancer surgery, and the procedure has become the gold standard for curative resection of rectal cancer. In this article, we discuss the evolution of the standard abdominal approach to the TME, with emphasis on the history, relevant anatomy, standard procedure steps, oncologic outcomes, and technical evolution.

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Meta-analysis of the impact of surgical approach on the grade of mesorectal excision in rectal cancer

Abstract: Small differences in mesorectal quality were evident between open and laparoscopic rectal resections. This may be attributable to use of laparoscopic instruments; however, to date minor defects have not affected oncological outcomes.

Cited by 43 publications

References 44 publications

A propensity‐score‐matched analysis of laparoscopic vs open surgery for rectal cancer in a population‐based study

A propensity‐score‐matched analysis of laparoscopic vs open surgery for rectal cancer in a population‐based study

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

Total Mesorectal Excision Technique—Past, Present, and Future

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