Robotic total mesorectal excision or transanal total mesorectal excision meta‐analysis

Abstract

Backgrounds: Total mesorectal excision (TME) has been established as the standard for oncologic resection of rectal cancer, and has a direct impact on local recurrence and overall survival. Objectives: Our meta-analysis aims to evaluate the oncological outcomes of the newer techniques of TMErobotic TME versus Transanal TME (TaTME). Primary outcome measures included CRM positivity, R0 resection status, distal resection margins and lymph node yield. Secondary outcome measures were overall complication rates, anastomotic leak and wound infection rates, post-operative ileus rates and mean operative time. Methods: A systematic literature search was performed to identify relevant studies through PubMEd and Embase from January 2000 to January 2021. Inclusion criteria included English language articles directly comparing TaTME and robotic TME. Results: Seven hundred and fourteen studies were identified, and only six studies were included for this meta-analysis. A total of 1065 participants, of which 632 (59.3%) underwent robotic TME, and 433 (40.7%) had TaTME. Robotic TME had a statistically significant higher lymph node yield (SMD -0.53, p = 0.020). There were no significant differences in the overall complication rates, wound infection and anastomotic leak rates, post-operative ileus, mean operative time and CRM positivity. Conclusion: This is the first meta-analysis assessing the outcomes of robotic TME versus TaTME, and only lymph node yield was statistically higher in robotic TME group. These techniques are potentially complementary rather than competing, and we believe that these two approaches can be adopted after appropriate training.

Escisión meso-rectal total por vía trans anal (TaTME). Experiencia institucional

“…El uso de la cirugía mínimamente invasiva por vía trans anal ha crecido de forma paulatina en los últimos años, demostrado su eficacia, a pesar de una curva de aprendizaje difícil, y del costo que genera contar con los instrumentos necesarios 19 . En nuestra experiencia, el tiempo operatorio ha ido disminuyendo de forma significativa a lo largo del tiempo, lo cual va de la mano con la curva de aprendizaje, siendo los primeros promedios superiores a los 200 minutos y los últimos de alrededor de 120 minutos.…”

“…El porcentaje de meso-rectos calificados debe ser del 100 %, ya que lograr una adecuada escisión meso-rectal total es el desenlace más importante y determinante como factor pronóstico de recurrencia en los pacientes oncológicos llevados a manejo quirúrgico del cáncer de recto 7,11,19,20 . En cuanto al informe del meso-recto en nuestra cohorte, 13 pacientes (46,5 %) tenían un reporte de su calidad, y de ellos, el 92,4 % fueron "completos" y uno "casi completo" lo que permite unificarlos como un meso-recto de adecuada calidad, pero no es posible evaluar si la curva de aprendizaje está siendo reflejada en la calidad del meso-recto, ni determinar si se está logrando o no una escisión meso-rectal total.…”

Prince and princesses: The current status of robotic surgery in surgical oncology

“…130 Early data comparing the taTME to rTME does not find significant difference in short-term outcomes, but higher level evidence is needed. 131,132 While there are no current RCTs comparing the two approaches, the planned ROTA trial will investigate 3-year DFS. utilization of an open approach decreased (p < 0.0001).…”

“…Long‐term outcomes are still under investigation after a moratorium was placed on taTME in Norway due to observed high recurrence rates 130 . Early data comparing the taTME to rTME does not find significant difference in short‐term outcomes, but higher level evidence is needed 131,132 . While there are no current RCTs comparing the two approaches, the planned ROTA trial will investigate 3‐year DFS 133 …”