Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study-Reference-Cited by-同舟云学术

Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study

Published:2024-05-08 Issue:3 Volume:8 Page:
ISSN:2474-9842
Container-title:BJS Open
language:en
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Author:

de’Angelis Nicola¹^ORCID,Marchegiani Francesco²³^ORCID,Martínez-Pérez Aleix⁴⁵,Biondi Alberto⁶^ORCID,Pucciarelli Salvatore⁷^ORCID,Schena Carlo Alberto¹^ORCID,Pellino Gianluca⁸^ORCID,Kraft Miquel⁸,van Lieshout Annabel S⁹,Morelli Luca¹⁰,Valverde Alain¹¹,Lupinacci Renato Micelli¹¹,Gómez-Abril Segundo A⁴,Persiani Roberto⁶,Tuynman Jurriaan B⁹,Espin-Basany Eloy⁸,Ris Frederic¹², ,Bianchi Giorgio,Martí-Martínez Eva,Torres-Sánchez Teresa,Sebastián-Tomás Juan Carlos,Maretto Isacco,Spolverato Gaya,Guadagni Simone,Solis Alejandro

Affiliation:

1. Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital , Ferrara (Cona), Italy

2. Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP) , Clichy , France

3. University Paris Cité , Paris , France

4. Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset , Valencia , Spain

5. Biosanitary Research Institute, Valencian International University (VIU) , Valencia , Spain

6. General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy

7. General Surgery 3, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy

8. Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona , Barcelona , Spain

9. Department of Surgery, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam , Amsterdam , The Netherlands

10. General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Pisa , Italy

11. Department of Digestive Surgery, Groupe Hospitalier Diaconesses, Croix Saint-Simon , Paris , France

12. Service of Abdominal Surgery, Geneva University Hospitals and Medical School , Geneva , Switzerland

Abstract

Abstract Background 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). Methods 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. Results 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. Conclusion 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.

Publisher

Oxford University Press (OUP)

Link

https://academic.oup.com/bjsopen/article-pdf/8/3/zrae044/58347125/zrae044.pdf

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