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Related Concept Videos

Cancer Survival Analysis01:21

Cancer Survival Analysis

Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...

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Related Experiment Video

Updated: Jul 15, 2026

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Volume-Outcome Relationships in Total Mesorectal Excision Quality and Grading: A National Cancer Database Study.

Aubrey C Swilling1, Prabhakar Chalise2, Mazin Al-Kasspooles1

  • 1Colorectal and Oncologic Surgery Division, Department of Surgery, The University of Kansas Medical Center, Kansas City, KS, USA.

Annals of Surgical Oncology
|February 17, 2026
PubMed
Summary

High-volume hospitals achieve better total mesorectal excision (TME) quality for rectal cancer patients. Robotic surgery is linked to the highest rates of complete TME, improving outcomes.

Keywords:
Rectal cancerRobotic surgeryTotal mesorectal excisionVolume-outcome relationship

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastrointestinal Surgery

Background:

  • Total mesorectal excision (TME) is the gold standard surgical procedure for mid-to-low rectal cancer.
  • The Commission on Cancer mandates TME grading documentation for quality assessment.
  • Understanding national variations in TME quality is crucial for improving patient care.

Purpose of the Study:

  • To analyze national variations in the reporting and quality of total mesorectal excision (TME).
  • To assess the impact of hospital volume and surgical approach on TME quality.
  • To correlate TME quality with key surgical outcomes such as lymph node yield and margin status.

Main Methods:

  • A retrospective cohort study of 5033 rectal adenocarcinoma patients who underwent TME in 2022.
  • Data sourced from the National Cancer Database.
  • Analysis of TME reporting and completeness based on institutional volume quartiles and the Leapfrog Group's benchmark (16 proctectomies/year).
  • Exploration of associations between TME grades, surgical approach (robotic, laparoscopic, open), lymph node yield, and surgical margins.

Main Results:

  • Higher hospital volume was significantly associated with increased likelihood of TME reporting and achieving complete TME grades.
  • Meeting the Leapfrog minimum volume did not correlate with more complete TME grades.
  • Robotic-assisted surgery demonstrated the highest rate of complete TME and lower conversion rates compared to laparoscopic approaches.
  • Complete TME was significantly linked to achieving at least 12 lymph nodes, no residual tumor, and negative circumferential resection margins.

Conclusions:

  • High-volume institutions excel in TME reporting and achieving complete TME, correlating with superior lymph node yield and negative margins.
  • Robotic-assisted surgery is associated with the highest rates of complete TME.
  • These findings highlight the importance of institutional volume and surgical technique in optimizing TME quality for rectal cancer treatment.