Robotic versus laparoscopic sphincter‐preserving total mesorectal excision: A propensity case‐matched analysis

Abstract

Background Robotic total mesorectal excision (R‐TME) is expected to have advantages over laparoscopic total mesorectal excision (L‐TME). The aim is to compare the short‐term outcomes between initial cases of L‐TME and RTME. Materials and methods Among a total of 168 patients assigned to receive either R‐TME (n = 84) or L‐TME (n = 84), short term outcomes were compared between the groups by 1:1 propensity score matching of eight variables. Results The inter‐sphincteric resection rate (42.9% vs. 25%; P = 0.006) and operative time (372.4 ± 102.8 vs. 301 ± 53.6, P = 0.000) were significantly greater in R‐TME. The conversion rate, blood loss, and length of hospital stay were similar. The anastomotic leak rate and major surgical complications rates were significantly higher in L‐TME (9.5% vs. 1.2%; P = 0.016) and (13.1% vs. 4.8%; P = 0.034) respectively. Conclusion The oncologic quality and short‐term outcomes in the two groups were comparable; however, anastomotic leak rates and major complications were significantly lower in R‐TME. For experienced laparoscopic surgeons, robotic sphincter‐saving TME is associated with lower morbidity when compared with laparoscopic approach.

The severity of postoperative complications after robotic versus laparoscopic surgery for rectal cancer: A systematic review, meta-analysis and meta-regression

“…Current study reported that robotic surgery was associated with a lower rate of anastomotic leak than laparoscopic surgery (4.76% vs. 7.36%), which was inconsistent with previous literature [ 8 , 10 , 36 , 38 ] . We found that robotic surgery was with a lower rate of anastomotic leak in only three of the fourteen involved studies [ 24 , 32 , 33 ] , and the both groups showed a significant difference in patient characteristics such as age, tumor distance from anal verge, surgical procedure, and ileostomy. Some of these factors were the independent risk factors of anastomotic leakage [ 42 , 43 ] , which may contribute to this result to a certain extent.…”

Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer

“…We routinely perform laparoscopic and robotic TME for locally advanced CRC. 33 The refinement of the surgical technique along with its standardization, better perioperative care, advances in interventional radiology, implementation of multidisciplinary team approach and careful patient selection have helped us to adopt MIS for PE in our center. 9 The magnified view in the pelvis that is narrow and deep, the privilege of executing a meticulous dissection and careful transection of the small branches of internal iliac vessels, the controlled dissection of the distal part of ureters and uretero-vesical junction, and inter-sphincteric space in case of supralevator exenteration have encouraged us to perform more MIS procedures.…”

Current approaches in intensification of long-course chemoradiotherapy in locally advanced rectal cancer: a review

“…Currently, the mainstay treatment for locally advanced rectal cancer (LARC) is total mesorectal excision (TME), either open or using minimally invasive methods like robotic or laparoscopic surgery [ 3 ]. Compared to the colon, the cancers of the rectum harbor distinct considerations, including the limited space to obtain sufficient margins and to dissect lateral lymph node in the true pelvis [ 3 , 4 ]. Due to these considerations, adjuvant chemoradiation (CRT) has increased the survival of rectal cancer patients and decreased the likelihood of local recurrence (LR).…”