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Robotic or transanal total mesorectal excision (TaTME) approach for rectal cancer, how about both? Feasibility and outcomes from a single institution

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Abstract

Laparoscopic surgery for rectal cancer is technically challenging. Robotic and transanal TME (TaTME) are both novel approaches developed to provide better visualization and dissection. We aim to combine both approaches in a hybrid procedure and evaluate the feasibility as well as patient and oncological outcomes in this study. A review of a prospectively maintained database of patients who underwent a hybrid abdominal robotic approach with TaTME for rectal cancer between January 2016 and October 2018 was undertaken. Patient demographics, tumor characteristics and surgical outcomes were recorded and analyzed. A total of 69 patients (43 males, 26 females) received this hybrid approach. Their median age was 58 years (range 35–87) with a mean BMI of 24.3 kg/m2 (range 16.4–44.2). Median distance from anal verge was 5 cm (range 2–9). The patients had a median hospital length of stay of 7 days (range 5–28). Complication rate was 17.4% (12 patients) with 3 patients (4.3%) requiring a reoperation. TME quality was optimal with all of them either complete (81.2%) or almost complete (18.8%). 65 patients (94.2%) had an R0 resection with 4 patients (5.8%) with involved circumferential resection margins (≤ 1 mm). The median number of lymph nodes harvested was 20 (range 6–37). After a median follow-up of 27.7 months (range 7–42), local recurrence was identified in 2 patients (4%). Three patients (5.2%) had distant recurrence at the 3-year mark. Hybrid robotic abdominal dissection with transanal TME for rectal cancer appears to be feasible with comparable surgical outcomes to other traditional approaches.

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References

  1. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, Brown JM (2013) Long-term follow-up for the Medical Research Council CLASICC trial of conventional vs laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82

    Article  CAS  Google Scholar 

  2. van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, Bonjer HJ, Colorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomized, phase 3 trial. Lancet Oncol. 14:210–218

    Article  Google Scholar 

  3. Bondeven P, Hagemann Madsen RH, Laurberg S, Pedersen BG (2013) Extent and completeness of mesorectal excision evaluated by postoperative magnetic resonance imaging. Br J Surg 100(10):1357–1367

    Article  CAS  Google Scholar 

  4. D’Annibale A, Pernazza G, Monsellato I, Pende V, Lucandri G, Mazzocchi P, Alfano G (2013) Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 27:1887–1895

    Article  Google Scholar 

  5. Kwak JM, Kim SH, Kim J, Son DN, Baek SJ, Cho JS (2011) Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study. Dis Colon Rectum 54:151–156

    Article  Google Scholar 

  6. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Edlin R, Hulme C, Brown J (2019) Robotic-assisted surgery compared with laparoscopic resection surgery for rectal cancer: the ROLARR RCT. Efficacy Mech Eval. 6(10):1–140

    Article  Google Scholar 

  7. Chen CC, Lai YL, Jiang JK, Chu CH, Huang IP, Chen WS, Cheng AY, Yang SH (2016) Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: a matched case-control study. Ann Surg Oncol 23:1169–1176

    Article  Google Scholar 

  8. Larsen SG, Pfeffer F, Korner H, Norwegian Colorectal Cancer Group (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg. 106:1120–1121

    Article  CAS  Google Scholar 

  9. Veltcamp HM, van Oostendorp SE, Koedam TWA, Knol JJ, Stockmann HBAC, Oosterling SJ, Vuylsteke RCLM, de Graaf EJR, Doornebosch PG, Hompes R, Bonjer HJ, Sietses C, Tuynman JB (2020) Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands. Surg Endosc 34(1):192–201

    Article  Google Scholar 

  10. Emile SH, de Lacy FB, Keller DS, Beatriz MP, Sadir A, Lacy AM, Manish C (2018) Evolution of transanal total mesorectal excision for rectal cancer: from top to bottom. World J Gastrointest Surg 10:28–39

    Article  Google Scholar 

  11. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, TaTME Registry Collaborative (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266:111–117

    Article  Google Scholar 

  12. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318:1569–1580

    Article  Google Scholar 

  13. Bravo R, Trépanier JS, Arroyave MC, Fernandez-Hevia M, Pigazzi A, Lacy AM (2017) Combined transanal total mesorectal excision (TaTME) with laparoscopic instruments and abdominal robotic surgery in rectal cancer. Tech Coloproctol 21(3):233–235

    Article  CAS  Google Scholar 

  14. Nikolic A, Waters PS, Peacock O, Choi CC, Rajkomar A, Heriot AG, Smart P, Warrier S (2020) Hybrid abdominal robotic approach with conventional transanal total mesorectal excision (TaTME) for rectal cancer: feasibility and outcomes from a single institution. J Robot Surg 14(4):633–641

    Article  Google Scholar 

  15. Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, Abbott CR, Scott N, Finan PJ, Johnston D, Quirke P (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235:449–457

    Article  Google Scholar 

  16. Nikberg M, Kindler C, Chabok A, Letocha H, Shetye J, Smedh K (2015) Circumferential resection margin as a prognostic marker in the modern multidisciplinary management of rectal cancer. Dis Colon Rectum 58:275–282

    Article  Google Scholar 

  17. Rickles AS, Dietz DW, Chang GJ, Wexner SD, Berho ME, Remzi FH, Greene FL, Fleshman JW, Abbas MA, Peters W, Noyes K, Monson JR, Fleming FJ, Consortium for Optimizing the Treatment of Rectal Cancer (OSTRiCh) (2015) High rate of positive circumferential resection margins following rectal cancer surgery: a call to action. Ann Surg 262:891–898

    Article  Google Scholar 

  18. Lee L, de Lacy B, Gomez Ruiz M, Liberman AS, Albert MR, Monson JRT, Lacy A, Kim SH, Atallah SB (2019) A multicenter matched comparison of transanal and robotic total mesorectal excision for mid and low rectal adenocarcinoma. Ann Surg 270(6):1110–1116

    Article  Google Scholar 

  19. Adamina M, Buchs NC, Penna M, Hompes R, St Gallen Colorectal Consensus Expert Group (2018) St. Gallen Colorectal Consensus Expert G: St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc 32:1091–1103

    Article  Google Scholar 

  20. Lee CH, Cheng SC, Tung HY, Chang SC, Ching CY, Wu SF (2018) The risk factors affecting survival in colorectal cancer in Taiwan. Iran J Public Health 47:519–530

    PubMed  PubMed Central  Google Scholar 

  21. Penna M, Hompes R, Arnold S, Greg W, Ralph A, Janindra W, Brendan M, George BH, Neil JM, Paris PT, TaTME Registry Collaborative (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 266:111–117

    Article  Google Scholar 

  22. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D, MRC CR07/NCIC-CTG CO16 Trial Investigators, NCRI Colorectal Cancer Study Group (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR1 and NCIC-CTG CO16 randomized clinical trial. Lancet 373(9666):821–828

    Article  Google Scholar 

  23. Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N (2008) Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23:703–707

    Article  Google Scholar 

  24. Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21(15):2912–2919

    Article  Google Scholar 

  25. de Campos-Lobato LF, Stocchi L, de Sousa JB, Buta M, Lavery IC, Fazio VW, Dietz DW, Kalady MF (2013) Less than 12 nodes in the surgical specimen after total mesorectal excision following neoadjuvant chemoradiation: it means more than you think! Ann Surg Oncol 20(11):3398–3406

    Article  Google Scholar 

  26. Ma B, Gao P, Song Y, Zhang C, Zhang C, Wang L, Liu H, Wang Z (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 16:380

    Article  Google Scholar 

  27. Gómez Ruiz M, Parra IM, Palazuelos CM, Martin JA, Fernandez CC, Diego JC, Fleitas MG (2015) Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Dis Colon Rectum 58(1):145–153

    Article  Google Scholar 

  28. Wexner SD, Cohen SM (1995) Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 82:295–298

    Article  CAS  Google Scholar 

  29. Muratore A, Mellano A, Marsanic P, De Simone M (2015) Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol 41(4):478–483

    Article  CAS  Google Scholar 

  30. Perdawood SK, Thinggaard BS, Bjoern MX (2018) Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surg Endosc 32(5):2312–2321

    Article  Google Scholar 

  31. Lee KY, Shin JK, Park YA, Yun SH, Huh JW, Cho YB, Kim HC, Lee WY (2018) Transanal endoscopic and transabdominal robotic total mesorectal excision for mid-to-low rectal cancer: comparison of short-term postoperative and oncologic outcomes by using a case-matched analysis. Ann Coloproctol 34(1):29–35

    Article  Google Scholar 

  32. Law WL, Foo DCC (2018) Comparison of early experience of robotic and transanal total mesorectal excision using propensity score matching. Surg Endosc. https://doi.org/10.1007/s00464-018-6340-8

    Article  PubMed  Google Scholar 

  33. Alsowaina KN, Schlachta CM, Alkhamesi NA (2019) Cost effectiveness of current approaches in rectal surgery. Ann Med Surg 45:36–39

    Article  Google Scholar 

  34. Chen CC, Lai YL, Cheng AY, Chu CH, Huang IP, Yang SH (2019) Transanal total mesorectal excision for rectal cancer: hype or new hope? J Gastrointest Oncol 10(6):1193–1199

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan

    Yusuke Inoue

  2. Department of Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore

    Jing Yu Ng

  3. Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Centre, 125 Lide Road, Pei-Tou District, Taipei, Taiwan

    Chun-Ho Chu, Yi-Ling Lai, I.-Ping Huang & Chien-Chih Chen

  4. College of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chun-Ho Chu, Yi-Ling Lai, I.-Ping Huang, Shung-Haur Yang & Chien-Chih Chen

  5. Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan

    Shung-Haur Yang

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  1. Yusuke Inoue
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Correspondence to Chien-Chih Chen.

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The authors (Drs Yusuke Inoue, Jing Yu Ng, Chun-Ho Chu, Yi-Ling Lai, I-Ping Huang, Shung-Haur Yang, Chien-Chih Chen) have no conflicts of interest or financial ties to disclose.

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Inoue, Y., Ng, J.Y., Chu, CH. et al. Robotic or transanal total mesorectal excision (TaTME) approach for rectal cancer, how about both? Feasibility and outcomes from a single institution. J Robotic Surg 16, 149–157 (2022). https://doi.org/10.1007/s11701-021-01206-7

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  • DOI: https://doi.org/10.1007/s11701-021-01206-7

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