Surgical approach for rectal cancer: A network meta-analysis comparing open, laparoscopic, robotic and transanal TME approaches

Ryan, Odhrán K.; Ryan, Éanna J; Creavin, Ben; Rausa, Emanuele; Kelly, Michael E.; Petrelli, Fausto; Bonitta, Gianluca; Kennelly, Rory; Hanly, Ann; Martin, Seán T.; Winter, D. C.

doi:10.1016/j.ejso.2020.06.037

Cited by 34 publications

(22 citation statements)

References 89 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The initial report on TaTME was encouraging and met all the surgical quality indicator for TME resection. 6,15,17 This was further validated in a Dutch study comparing TaTME and laparosopic TME, 18 in which CRM involvement was similar in the two groups, 4.3% in TaTME and 4.0% in laparoscopic TME. 18 Short-term morbidity and oncologic outcomes were also comparable to laparoscopic TME series.…”

Section: Discussionmentioning

confidence: 81%

“…Major robotic TME versus laparoscopic TME studies have shown the robotic approach to maintain a low rate of CRM positivity of 0%-8%, and that robotic was non-inferior to laparoscopic approaches. 15 The RObotic versus LAparoscopic Resection for Rectal cancer (ROLARR) trial subsequently compared robotic and laparoscopic approaches, and the rate of conversion to open surgery. © 2021 Royal Australasian College of Surgeons.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Chen

Tay

Warrier

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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

Chen

Tay

Warrier

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Minimally invasive surgery for rectal cancer includes laparoscopy, TaTME, NOTES and robotic surgery, commonly practiced in many countries with satisfactory oncological results (18) ; however, there is not enough evidence in the Andean region of South America that support MIS as standard treatment for rectal cancer. There is only one comparative study between laparoscopic and open surgery performed in Chile that showed similarity between both techniques with promising results (19) .…”

Section: Discussionmentioning

confidence: 99%

Open versus minimally invasive sphincter-sparing surgery for rectal cancer: a single-center retrospective cohort study in Peru

Jabiles

Espinoza

Passiuri

et al. 2022

Rev Gastroenterol Peru

View full text Add to dashboard Cite

Objective: The study aimed to describe and compare minimally invasive surgery (MIS) and open surgery for rectal cancer in Peru. Material and methods: A retrospective single-center analysis was performed for all patients who underwent sphincter- sparing surgery for non-metastatic rectal cancer at Instituto Nacional de Enfermedades Neoplásicas in Peru between January 2016 and December 2020. Clinical, perioperative, pathological, and survival outcomes were compared between both groups. A propensity score matching method was used to minimize bias. Results: 162 patients were included in the final analysis. 124 had open surgery and 38 had MIS. Patients, clinical tumour, pathological characteristics, and perioperative were similar between groups after matching. Similar circumferential resection margin (CRM) with optimal quality of the mesorectum (p=1.000) but higher number of lymph nodes resected in open surgery group (p=0.741) was described. The leakage rate was slightly higher in the MIS group (p=0.358) with 10.5%, while the postoperative hospital stay was longer in the open surgery group after matching (p=0.001; OR 95% 5.2 CI: 1.8-15.6). The estimated recurrence-free survival (RFS) and overall survival (OS) at 3 years in open surgery and MIS was 71.8% (95% CI; 0.58-0.89) and 70% (95% CI; 0.56-0.88) (p=0.431) and 77.7% (95% CI; 0.64-0.94) and 88.9% (95% CI; 0.79-0.99) (p=0.5), respectively. Conclusions: Shorter postoperative hospital stay in the minimally invasive surgery group was reported. RFS, OS, and re lar between both groups. This approach is for non-metastatic rectal cancer in referral centers in Peru.

show abstract

“…Specifically, the best target for both taTME and robotic surgery is mid and lower rectal cancer. Several retrospective studies and meta-analyses have compared short-term outcomes after taTME and robotic surgery, 47,50,52 and both approaches have advantages and disadvantages; therefore, their relative superiority is as yet unclear. In Japan, more than 500 da Vinci Surgical Systems (Intuitive Surgical Inc., Sunnyvale, CA, USA) have been introduced in over 400 institutions, the second largest number in a single country in the world.…”

Section: Cost-effectiveness Of Tatmementioning

confidence: 99%

Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries

Uehara

Ogura

Murata

et al. 2022

Digestive Endoscopy

View full text Add to dashboard Cite

Transanal total mesorectal excision (taTME) has been rapidly accepted as a promising surgical approach to the distal rectum. The benefits include ease of access to the bottom of the deep pelvis linearly over a short distance in order to easily visualize the important anatomy. Furthermore, the distal resection margins can be secured under direct vision. Additionally, a two‐team approach combining taTME with a transabdominal approach could decrease the operative time and conversion rate. Although taTME was expected to become more rapidly popularized worldwide, enthusiasm for it has stalled due to unfamiliar intraoperative complications, a lack of oncologic evidence from randomized trials, and the widespread use of robotic surgery. While international registries have reported favorable short‐ and medium‐term outcomes from taTME, a Norwegian national study reported a high local recurrence rate of 9.5%. The characteristics of the recurrences included rapid, multifocal growth in the pelvis, which was quite different from recurrences following traditional transabdominal TME; thus, the Norwegian Colorectal Cancer Group reached a consensus for a temporary moratorium on the performance of taTME. To ensure acceptable baseline quality and patient safety, taTME should be performed by well‐trained colorectal surgeons. Although the appropriate indications for taTME remain controversial, the transanal approach is extremely important as a means of goal setting in difficult TME cases and as an aid to the transabdominal approach in various types of extended pelvic surgeries. The benefits in transanal lateral lymph node dissection and pelvic exenteration are presented herein.

show abstract

Surgical approach for rectal cancer: A network meta-analysis comparing open, laparoscopic, robotic and transanal TME approaches

Cited by 34 publications

References 89 publications

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

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

Open versus minimally invasive sphincter-sparing surgery for rectal cancer: a single-center retrospective cohort study in Peru

Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries

Contact Info

Product

Resources

About