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. 2022 Mar;29(3):1910-1920.
doi: 10.1245/s10434-021-10805-5. Epub 2021 Oct 4.

Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection: 3-Year Oncologic Results for a Population-Based Cohort in Experienced Centers

T A Burghgraef  1   2 , J C Hol  3   4 , M L Rutgers  5 , R M P H Crolla  6 , A A W van Geloven  7 , R Hompes  5 , J W A Leijtens  8 , F Polat  9 , A Pronk  10 , A B Smits  11 , J B Tuynman  4 , E G G Verdaasdonk  12 , P M Verheijen  1 , C Sietses  3 , E C J Consten  13   14
Affiliations

Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection: 3-Year Oncologic Results for a Population-Based Cohort in Experienced Centers

T A Burghgraef et al. Ann Surg Oncol. 2022 Mar.

Abstract

Background: Laparoscopic, robot-assisted, and transanal total mesorectal excision are the minimally invasive techniques used most for rectal cancer surgery. Because data regarding oncologic results are lacking, this study aimed to compare these three techniques while taking the learning curve into account.

Methods: This retrospective population-based study cohort included all patients between 2015 and 2017 who underwent a low anterior resection at 11 dedicated centers that had completed the learning curve of the specific technique. The primary outcome was overall survival (OS) during a 3-year follow-up period. The secondary outcomes were 3-year disease-free survival (DFS) and 3-year local recurrence rate. Statistical analysis was performed using Cox-regression.

Results: The 617 patients enrolled in the study included 252 who underwent a laparoscopic resection, 205 who underwent a robot-assisted resection, and 160 who underwent a transanal low anterior resection. The oncologic outcomes were equal between the three techniques. The 3-year OS rate was 90% for laparoscopic resection, 90.4% for robot-assisted resection, and 87.6% for transanal low anterior resection. The 3-year DFS rate was 77.8% for laparoscopic resection, 75.8% for robot-assisted resection, and 78.8% for transanal low anterior resection. The 3-year local recurrence rate was in 6.1% for laparoscopic resection, 6.4% for robot-assisted resection, and 5.7% for transanal procedures. Cox-regression did not show a significant difference between the techniques while taking confounders into account.

Conclusion: The oncologic results during the 3-year follow-up were good and comparable between laparoscopic, robot-assisted, and transanal total mesorectal technique at experienced centers. These techniques can be performed safely in experienced hands.

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Conflict of interest statement

Crolla, Verheijen, and Consten receive fees from Intuitive Surgical. No funding was received for this study. There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of patients included in the study. DCRA Dutch Colorectal Audit, TME total mesorectal excision, LAR low anterior resection, Lap laparoscopic, Robot robot-assisted, TaTME transanal TME, HIPEC hyperthermal intraperitoneal chemotherapy, IORT intraoperative radiotherapy, TEM transanal endoscopic microsurgery, APR abdominoperineal resection. Patients who underwent surgery in 2015 at a TaTME or robot-assisted center that started performing TaTME or robot-assisted TME respectively in 2014
Fig. 2
Fig. 2
Curves showing 3-year overall and disease-free survival. Lap laparoscopic low anterior resection, Robot robot-assisted low anterior resection, TaTME transanal total mesorectal excision
See this image and copyright information in PMC

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