Lawrence Lee1,2, Borja de Lacy3, Marcos Gomez Ruiz4, Alexander Sender Liberman2, Matthew R Albert1, John R T Monson1, Antonio Lacy3, Seon Hahn Kim5, Sam B Atallah6. 1. Center for Colon and Rectal Surgery, Surgical Health Outcomes Consortium (SHOC), Florida Hospital, Orlando, FL. 2. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada. 3. Department of Gastrointestinal Surgery, AIS Channel, Hospital Clinic Barcelona, Barcelona, Spain. 4. Department of Surgery, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain. 5. Department of Surgery, Korea University Anam Hospital, Seoul, South Korea. 6. Department of Colorectal Surgery, Florida Hospital, Orlando, FL.
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.
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-TMEpatients 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.
Authors: Evie Carchman; Daniel I Chu; Gregory D Kennedy; Melanie Morris; Marc Dakermandji; John R T Monson; Laura Melina Fernandez; Rodrigo Oliva Perez; Alessandro Fichera; Marco E Allaix; David Liska Journal: J Gastrointest Surg Date: 2018-09-13 Impact factor: 3.452
Authors: Ravish Jootun; Pedja Cuk; Mark Ellebæk; Per Vadgaard Andersen; Søren Salomon; Gunnar Baatrup; Issam Al-Najami; Jim Khan Journal: Int J Surg Protoc Date: 2022-02-18
Authors: Marco Milone; Michel Adamina; Alberto Arezzo; Nona Bejinariu; Luigi Boni; Nicole Bouvy; F Borja de Lacy; Raphaëla Dresen; Konstantinos Ferentinos; Nader K Francis; Joe Mahaffey; Marta Penna; George Theodoropoulos; Katerina Maria Kontouli; Dimitris Mavridis; Per Olav Vandvik; Stavros A Antoniou Journal: Surg Endosc Date: 2022-02-25 Impact factor: 4.584