• J C Hol, T A Burghgraef, M L W Rutgers, CrollaR M P HRMPHDepartment of Surgery, Amphia Hospital, Breda, The Netherlands., N A W van Geloven, R Hompes, LeijtensJ W AJWADepartment of Surgery, Laurentius Hospital, Roermond, The Netherlands., F Polat, A Pronk, A B Smits, J B Tuynman, VerdaasdonkE G GEGGDepartment of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands., ConstenE C JECJDepartment of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands., and C Sietses.
• Department of Surgery, Amsterdam University Medical Centre, location VU Medical Centre, Amsterdam, The Netherlands.
• Br J Surg. 2021 Nov 11; 108 (11): 1380-1387.

BackgroundLaparoscopic total mesorectal excision (TME) surgery for rectal cancer has important technical limitations. Robot-assisted and transanal TME (TaTME) may overcome these limitations, potentially leading to lower conversion rates and reduced morbidity. However, comparative data between the three approaches are lacking. The aim of this study was to compare short-term outcomes for laparoscopic TME, robot-assisted TME and TaTME in expert centres.MethodsPatients undergoing rectal cancer surgery between 2015 and 2017 in expert centres for laparoscopic, robot-assisted or TaTME were included. Outcomes for TME surgery performed by the specialized technique in the expert centres were compared after propensity score matching. The primary outcome was conversion rate. Secondary outcomes were morbidity and pathological outcomes.ResultsA total of 1078 patients were included. In rectal cancer surgery in general, the overall rate of primary anastomosis was 39.4, 61.9 and 61.9 per cent in laparoscopic, robot-assisted and TaTME centres respectively (P < 0.001). For specialized techniques in expert centres excluding abdominoperineal resection (APR), the rate of primary anastomosis was 66.7 per cent in laparoscopic, 89.8 per cent in robot-assisted and 84.3 per cent in TaTME (P < 0.001). Conversion rates were 3.7 , 4.6 and 1.9 per cent in laparoscopic, robot-assisted and TaTME respectively (P = 0.134). The number of incomplete specimens, circumferential resection margin involvement rate and morbidity rates did not differ.ConclusionIn the minimally invasive treatment of rectal cancer more primary anastomoses are created in robotic and TaTME expert centres.© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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