Open Versus Laparoscopic Versus Robotic Versus Transanal Mesorectal Excision for Rectal Cancer: A Systematic Review...

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Evidence-Based Medicine

Background:

• Mesorectal excision is crucial for rectal cancer treatment.
• Various surgical techniques, including open, laparoscopic, robotic, and transanal approaches, are available.
• Comparative effectiveness data for these techniques are essential for clinical decision-making.

Purpose of the Study:

• To systematically compare the outcomes of different surgical techniques for rectal cancer resection.
• To evaluate perioperative morbidity, oncological results, and recovery parameters across open, laparoscopic, robotic, and transanal mesorectal excision.

Main Methods:

• Systematic literature review and Bayesian network meta-analysis.
• Inclusion of 29 randomized controlled trials with 6237 participants.
• Comparison of open, laparoscopic, robotic, and transanal mesorectal excision.

Main Results:

• No significant differences in major perioperative morbidities, survival, or recurrence rates were observed across techniques.
• Laparoscopic and robotic surgeries showed reduced operative blood loss and shorter hospital stays compared to open surgery.
• Laparoscopic surgery led to more incomplete mesorectal excisions, while robotic surgery resulted in longer distal resection margins.

Conclusions:

• Rectal cancer resection techniques demonstrate comparable long-term survival and perioperative morbidity.
• Laparoscopic and robotic approaches may offer advantages in postoperative recovery.
• Open and transanal techniques might provide superior oncological resection, necessitating individualized technique selection.