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Updated: Oct 17, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Association between technical difficulty and patient prognosis after transanal total mesorectal excision for middle
Weixiang Chen1,2, Jingtao Zhu1,2, Haipeng Weng1,2
1Department of Gastrointestinal Surgery 2 Section, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Background:
Whether technical difficulty influences outcomes after transanal total mesorectal excision (TaTME) for middle and low rectal cancer remains unclear. This study evaluated the association between technical difficulty and patient outcomes.
Methods:
This multicenter retrospective cohort study included 210 consecutive patients with middle and low rectal cancer who underwent TaTME at three centers in China. A five-item technical difficulty score was constructed using male sex, body mass index ≥ 25 kg/m2, distance from the anal verge ≤5 cm, tumor diameter ≥ 4 cm, and neoadjuvant therapy. Patients were classified into low (0-2 points) and high (3-5 points) technical difficulty groups. Surgical outcomes, recurrence patterns, disease-free survival (DFS), overall survival (OS), and conditional survival were compared.
Results:
Overall, 130 patients were classified into the low technical difficulty group and 80 into the high technical difficulty group. The high technical difficulty group had a longer operative time (249.0 ± 60.0 vs. 220.3 ± 50.1 min, P < 0.001), but major short-term outcomes did not differ significantly. The 3-year DFS and OS rates were 80.2% and 89.0%, respectively. Forty postoperative recurrences were recorded, mainly distant metastases, with most occurring within 2 years. Overall recurrence (17.7% vs. 21.2%, P = 0.588) and local recurrence (3.8% vs. 2.5%, P = 0.711) were comparable between groups. High technical difficulty was not independently associated with DFS (HR 1.06, 95% CI 0.57-2.00, P = 0.849) or OS (HR 1.21, 95% CI 0.52-2.81, P = 0.664).
Conclusion:
Technical difficulty in TaTME was mainly reflected by prolonged operative time and was not significantly associated with increased local recurrence or reduced 3-year DFS/OS. Early surveillance for systemic recurrence remains important.
