Related Experiment Video
Updated: Jun 6, 2025
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Histopathological outcomes of transanal, robotic, open, and laparoscopic surgery for rectal cancer resection. A
Nicola de'Angelis1, Carlo Alberto Schena2, Danila Azzolina3
1Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, via Aldo Moro 8, 44124, Ferrara, Cona), Italy; Department of Translational Medicine and LTTA Centre, University of Ferrara, 44121, Ferrara, Italy.
Background:
While total mesorectal excision is the gold standard for rectal cancer, the optimal surgical approach to achieve adequate oncological outcomes remains controversial. This network meta-analysis aims to compare the histopathological outcomes of robotic (R-RR), transanal (Ta-RR), laparoscopic (L-RR), and open (O-RR) resections for rectal cancer.
Materials And Methods:
MEDLINE, Embase, and the Cochrane Library were screened from inception to June 2024. Of the 4186 articles screened, 27 RCTs were selected. Pairwise comparisons and Bayesian network meta-analyses applying random effects models were performed.
Results:
The 27 RCTs included a total of 8696 patients. Bayesian pairwise meta-analysis revealed significantly lower odds of non-complete mesorectal excision with Ta-RR (Odds Ratio, OR, 0.60; 95%CI, 0.33, 0.92; P = .02; I2:11.7 %) and R-RR (OR, 0.68; 95%CI, 0.46, 0.94; P = .02; I2:41.7 %) compared with laparoscopy. Moreover, lower odds of positive CRMs were observed in the Ta-RR group than in the L-RR group (OR, 0.36; 95%CI, 0.13, 0.91; P = .02; I2:43.9 %). The R-RR was associated with more lymph nodes harvested compared with L-RR (Mean Difference, MD, 1.24; 95%CI, 0.10, 2.52; P = .03; I2:77.3 %). Conversely, Ta-RR was associated with a significantly lower number of lymph nodes harvested compared with all other approaches. SUCRA plots revealed that Ta-RR had the highest probability of being the best approach to achieve a complete mesorectal excision and negative CRM, followed by R-RR, which ranked the best in lymph nodes retrieved.
Conclusion:
When comparing the effectiveness of the available surgical approaches for rectal cancer resection, Ta-RR and R-RR are associated with better histopathological outcomes than L-RR.
Insights
Transanal (Ta-RR) and robotic (R-RR) resections show better histopathological outcomes for rectal cancer compared to laparoscopy (L-RR). Ta-RR and R-RR offer improved complete mesorectal excision and negative circumferential resection margins, enhancing oncological results.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Total mesorectal excision (TME) is the standard for rectal cancer surgery.
- Optimal surgical techniques for TME remain debated.
- This study compares histopathological outcomes of robotic, transanal, laparoscopic, and open rectal resections.
Purpose of the Study:
- To compare the histopathological outcomes of robotic (R-RR), transanal (Ta-RR), laparoscopic (L-RR), and open (O-RR) resections for rectal cancer.
- To determine the most effective surgical approach for achieving optimal oncological results in rectal cancer treatment.
Main Methods:
- A systematic literature search was conducted across MEDLINE, Embase, and the Cochrane Library.
- Twenty-seven randomized controlled trials (RCTs) involving 8696 patients were included.
- Bayesian network meta-analyses were performed to compare histopathological outcomes.
Main Results:
- Transanal (Ta-RR) and robotic (R-RR) resections demonstrated significantly lower odds of incomplete mesorectal excision compared to laparoscopy (L-RR).
- Ta-RR showed lower odds of positive circumferential resection margins (CRMs) than L-RR.
- R-RR had more lymph nodes harvested than L-RR, while Ta-RR had fewer lymph nodes harvested than all other approaches.
Conclusions:
- Transanal (Ta-RR) and robotic (R-RR) resections are associated with superior histopathological outcomes compared to laparoscopic (L-RR) rectal cancer resection.
- Ta-RR and R-RR demonstrate potential for improved oncological control in rectal cancer surgery.
