Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer : European multicentre, propensity score-matched study
de'Angelis, Nicola (Ferrara University Hospital)
Marchegiani, Francesco
Martínez-Pérez, Aleix (Hospital Universitari Doctor Peset (València))
Biondi, Alberto (Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Roma, Itàlia))
Pucciarelli, Salvatore (University of Padua)
Schena, Carlo Alberto (University of Padua)
Pellino, Gianluca (Hospital Universitari Vall d'Hebron)
Kraft, Miquel (Hospital Universitari Vall d'Hebron)
van Lieshout, Annabel S. (Location Vrije Universiteit Amsterdam)
Morelli, Luca (Azienda Ospedaliero Universitaria Pisana (Itàlia))
Valverde, Alain (Groupe Hospitalier Diaconesses, Croix Saint-Simon (Paris, França))
Lupinacci, Renato Micelli (Università di Pisa)
Gómez-Abril, Segundo A. (Hospital Universitari Doctor Peset (València))
Persiani, Roberto (Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Roma, Itàlia))
Tuynman, Jurriaan B. (Amsterdam UMC. University Medical Center)
Espin-Basany, Eloy (Hospital Universitari Vall d'Hebron)
Ris, Frederic (Geneva University Hospitals and Medical School (Ginebra, Suïssa))

Data:	2024
Resum:	Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME). Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival. A total of 468 patients (mean(s. d. ) age of 64. 1(11) years) were included; 190 (40. 6%) patients underwent laparoscopic TME, 141 (30. 1%) patients underwent robotic TME, and 137 (29. 3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1. 80, 95% c. i. 1. 11-2. 91) and transanal TME (OR 2. 87, 95% c. i. 1. 72-4. 80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8. 8%) and transanal TME (8. 1%) (P = 0. 031). Robotic TME (1. 4%) and transanal TME (0. 7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8. 8%) (P < 0. 001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0. 003 and 0. 001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival. In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME. The aim of this study was to compare three minimally invasive surgical approaches for total mesorectal excision with primary anastomosis (laparoscopic total mesorectal excision, robotic total mesorectal excision, and transanal total mesorectal excision) using propensity score matching analysis. Newer minimally invasive approaches (robotic total mesorectal excision and transanal total mesorectal excision) demonstrated improved outcomes compared with laparoscopic total mesorectal excision.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	BJS Open, Vol. 8 (may 2024) , ISSN 2474-9842

DOI: 10.1093/bjsopen/zrae044
PMID: 38805357

10 p, 261.0 KB

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