A multicenter matched comparison of transanal and robotic total mesorectal excision for mid and low-rectal adenocarcinoma

Lawrence Lee, Borja de Lacy, Marcos Gomez Ruiz, Alexander Sender Liberman, Matthew R. Albert, John R.T. Monson, Antonio Lacy, Seon Hahn Kim, Sam B. Atallah

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: To compare the quality of surgical resection of transanal total mesorectal excision (TA-TME) and robotic total mesorectal excision (R-TME). Background: Both TA-TME and R-TME have been advocated to improve the quality of surgery for rectal cancer below 10 cm from the anal verge, but there are little data comparing TA-TME and R-TME. Methods: Data of patients undergoing TA-TME or R-TME for rectal cancer below 10 cm from the anal verge and a sphincter-saving procedure from 5 high-volume rectal cancer referral centers between 2011 and 2017 were obtained. Coarsened exact matching was used to create balanced cohorts of TA-TME and R-TME. The main outcome was the incidence of poor-quality surgical resection, defined as a composite measure including incomplete quality of TME, or positive circumferential resection margin (CRM) or distal resection margin (DRM). Results: Out of a total of 730 patients (277 TA-TME, 453 R-TME), matched groups of 226 TA-TME and 370 R-TME patients were created. These groups were well-balanced. The mean tumor height from the anal verge was 5.6 cm (SD 2.5), and 70% received preoperative radiotherapy. The incidence of poor-quality resection was similar in both groups (TA-TME 6.9% vs R-TME 6.8%; P = 0.954). There were no differences in TME specimen quality (complete or near-complete TA-TME 99.1% vs R-TME 99.2%; P = 0.923) and CRM (5.6% vs 6.0%; P = 0.839). DRM involvement may be higher after TA-TME (1.8% vs 0.3%; P = 0.051). Conclusions: High-quality TME for patients with rectal adenocarcinoma of the mid and low rectum can be equally achieved by transanal or robotic approaches in skilled hands, but attention should be paid to the distal margin.

Original languageEnglish
Pages (from-to)1110-1116
Number of pages7
JournalAnnals of surgery
Volume270
Issue number6
DOIs
Publication statusPublished - 2019 Dec 1

Keywords

  • Rectal cancer
  • Robotics
  • Transanal total mesorectal excision

ASJC Scopus subject areas

  • Surgery

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    Lee, L., de Lacy, B., Ruiz, M. G., Liberman, A. S., Albert, M. R., Monson, J. R. T., Lacy, A., Kim, S. H., & Atallah, S. B. (2019). A multicenter matched comparison of transanal and robotic total mesorectal excision for mid and low-rectal adenocarcinoma. Annals of surgery, 270(6), 1110-1116. https://doi.org/10.1097/SLA.0000000000002862