Comparison of transanal total mesorectal excision and robotic total mesorectal excision for low rectal cancer after neoadjuvant chemoradiotherapy

• Published in: Surgical endoscopy Vol. 35; no. 12; pp. 6998 - 7004
• Main Authors: Shin, Jung Kyong, Kim, Hee Cheol, Yun, Seong Hyeon, Park, Yoon Ah, Cho, Yong Beom, Huh, Jung Wook, Lee, Woo Yong
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2021; Springer Nature B.V
• Subjects: Abdominal Surgery; Anus; Cancer therapies; Catheters; Chemotherapy; Colorectal cancer; Dissection; Endoscopy; Gastroenterology; Gynecology; Hepatology; Humans; Laparoscopy; Medicine; Medicine & Public Health; Neoadjuvant Therapy; Postoperative Complications; Proctology; Radiation therapy; Rectal Neoplasms - surgery; Rectum; Rectum - surgery; Retrospective Studies; Robotic Surgical Procedures; Robotics; Surgery; Surgical techniques; Transanal Endoscopic Surgery; Treatment Outcome; Robotic TME; Total mesorectal excision; Transanal TME; Rectal cancer; Neoadjuvant chemoradiotherapy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-020-08213-z

Background To improve the quality of surgery for rectal cancer, both transanal total mesorectal excision (taTME) and robotic total mesorectal excision (R-TME) can be performed. However, few studies have compared outcomes of taTME and R-TME, especially for patients with low rectal cancer after undergoing neoadjuvant chemoradiation (nCRT). Thus, the objective of this study was to compare outcomes of taTME and R-TME for patients with low rectal cancer after undergoing nCRT. Methods A total of 306 consecutive patients with low rectal cancer who underwent taTME or R-TME after nCRT between 2008 and 2018 were analyzed retrospectively. Patients were classified into two groups: 1) taTME surgery group ( n  = 94); and 2) R-TME surgery group ( n  = 212). Results Clinicopathologic variables were comparable between the two groups. There was no significant difference in circumference margin involvement (1.1% in taTME vs. 2.8% in R-TME, p  = 0.680) or distal resection margin (2.3 cm in taTME vs. 2.4 cm in R-TME, p  = 0.629). Total operation time (239 min in taTME vs. 243 min in R-TME, p  = 0.675) and major complications (including anastomosis site leakage, surgical site infection, and voiding difficulty) showed no significant difference between the two groups either. Conclusions Transanal and robotic TMEs have similar short-term outcomes for patients with rectal cancer after undergoing nCRT. High quality TME can be equally achieved with both transanal and robotic approaches.