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Integrating a tumour appropriate transanal or robotic assisted approach to total mesorectal excision in high-volume rectal cancer practice is safe and cost-effective

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Abstract

Total mesorectal excision (TME) is accepted as the gold standard for oncological resection in rectal cancer. The best approach to TME is debated and often surgeons will select a preferred approach. In this study, we aimed to describe how both robotic (R-TME) and transanal (TaTME) TME can be integrated into high-volume rectal cancer surgeon practice with a comparison of clinical and oncological outcomes and cost analysis. A prospective comparative cohort study was performed in a high-volume rectal cancer centre comparing the previous 50 R-TME and 50 TaTME performed by the same surgeon. A comparison of tumour characteristics was performed to highlight a specific role for each technique. Clinical outcomes (operative duration, length of stay (LOS) and perioperative morbidity), cancer quality indicators (resection margin and completeness of TME) and cost analysis were compared. Statistical analysis was performed using IBM SPSS, version 20. R-TME was preferred in mid-rectal cancer, compared to TaTME preferred in low rectal cancer (9 cm vs. 5 cm, p < 0.001). Operative duration was longer in R-TME compared to TaTME (265 vs. 179 min, p < 0.001). Major complications (CD III–IV complications) were experienced in 10% of R-TME and 14% of TaTME (p = 0.476). A 98% (n = 49) clear R0 resection margin was achieved with both R-TME and TaTME and mesorectum quality defined as ‘complete’ in 86% (n = 43) in R-TME and 82% (n = 41) in TaTME. Length of hospital stay was shorter in R-TME (5 vs. 7 days, p = 0.624). An overall difference of €131 was observed favouring TaTME. In high-volume rectal cancer surgery practice, both R-TME and TaTME can be practised and tailored according to patients and tumour characteristics, with comparable clinical and cancer outcomes and is cost-effective.

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Funding

No funding was specifically received for this study. The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Colorectal Surgery, CHU Bordeaux, Bordeaux, France

    Christina Fleming, Benjamin Fernandez, Lara Boissieras & Thomas Cauvin

  2. Bordeaux Colorectal Institute, Clinique Tivoli, 220 Rue Mandron, 33000, Bordeaux, France

    Quentin Denost

Authors
  1. Christina Fleming
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  2. Benjamin Fernandez
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  3. Lara Boissieras
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  4. Thomas Cauvin
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  5. Quentin Denost
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Contributions

CF: study conceptualisation, study design, data synthesis and analysis, manuscript draft, manuscript final approval BF: data synthesis and analysis, manuscript draft, manuscript final approval LB: data synthesis and analysis, manuscript draft, manuscript final approval TC: study design, data synthesis and analysis, manuscript draft, manuscript final approval QD: study conceptualisation, study design, data synthesis and analysis, manuscript draft, manuscript final approval.

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Correspondence to Quentin Denost.

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This study was performed in line with the principles of the Declaration of Helsinki.

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Fleming, C., Fernandez, B., Boissieras, L. et al. Integrating a tumour appropriate transanal or robotic assisted approach to total mesorectal excision in high-volume rectal cancer practice is safe and cost-effective. J Robotic Surg 17, 1979–1987 (2023). https://doi.org/10.1007/s11701-023-01577-z

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