Robotic rectal resection preserves anorectal function: Systematic review and meta-analysis.
LARS, minimally-invasive surgery
anorectal function
laparoscopy
rectal cancer
rectal resection
robotic surgery, total mesorectal excision
Journal
The international journal of medical robotics + computer assisted surgery : MRCAS
ISSN: 1478-596X
Titre abrégé: Int J Med Robot
Pays: England
ID NLM: 101250764
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
revised:
25
07
2021
received:
23
04
2021
accepted:
30
08
2021
pubmed:
1
9
2021
medline:
10
11
2021
entrez:
31
8
2021
Statut:
ppublish
Résumé
Improving survival rates in rectal cancer patients has generated a growing interest in functional outcomes after total mesorectal excision (TME). The well-established low anterior resection syndrome (LARS) score assesses postoperative anorectal impairment after TME. Our meta-analysis is the first to compare bowel function after open, laparoscopic, transanal, and robotic TME. All studies reporting functional outcomes after rectal cancer surgery (LARS score) were included, and were compared with a consecutive series of robotic TME (n = 48). Thirty-two publications were identified, including 5 565 patients. Anorectal function recovered significantly better within one year after robotic TME (3.8 [95%CI -9.709-17.309]) versus laparoscopic TME (26.4 [95%CI 19.524-33.286]), p = 0.006), open TME (26.0 [95%CI 24.338-29.702], p = 0.002) and transanal TME (27.9 [95%CI 22.127-33.669], p = 0.003). Robotic TME enables better recovery of anorectal function compared to other techniques. Further prospective, high-quality studies are needed to confirm the benefits of robotic surgery.
Sections du résumé
BACKGROUND
BACKGROUND
Improving survival rates in rectal cancer patients has generated a growing interest in functional outcomes after total mesorectal excision (TME). The well-established low anterior resection syndrome (LARS) score assesses postoperative anorectal impairment after TME. Our meta-analysis is the first to compare bowel function after open, laparoscopic, transanal, and robotic TME.
METHODS
METHODS
All studies reporting functional outcomes after rectal cancer surgery (LARS score) were included, and were compared with a consecutive series of robotic TME (n = 48).
RESULTS
RESULTS
Thirty-two publications were identified, including 5 565 patients. Anorectal function recovered significantly better within one year after robotic TME (3.8 [95%CI -9.709-17.309]) versus laparoscopic TME (26.4 [95%CI 19.524-33.286]), p = 0.006), open TME (26.0 [95%CI 24.338-29.702], p = 0.002) and transanal TME (27.9 [95%CI 22.127-33.669], p = 0.003).
CONCLUSIONS
CONCLUSIONS
Robotic TME enables better recovery of anorectal function compared to other techniques. Further prospective, high-quality studies are needed to confirm the benefits of robotic surgery.
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e2329Informations de copyright
© 2021 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.
Références
Tilney HS, Heriot AG, Purkayastha S, et al. A national perspective on the decline of abdominoperineal resection for rectal cancer. Ann Surg. 2008;247(1):77-84.
Acuna SA, Chesney TR, Ramjist JK, Shah PS, Kennedy ED, Baxter NN. Laparoscopic versus open resection for rectal cancer: a noninferiority meta-analysis of quality of surgical resection outcomes. Ann Surg. 2019;269(5):849-855.
Liao G, Li YB, Zhao Z, Li X, Deng H, Li G. Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence. Sci Rep. 2016;6:26981.
Aubert M, Mege D, Panis Y. Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach-a meta-analysis. Surg Endosc. 2019;34:3908-3919.
Tong G, Zhang G, Liu J, Zheng Z, Chen Y, Cui E. A meta-analysis of short-term outcome of laparoscopic surgery versus conventional open surgery on colorectal carcinoma. Medicine. 2017;96(48):e8957.
Jayne D, Pigazzi A, Marshall H, et al. 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. 2017;318(16):1569-1580.
Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C. Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc. 2016;30(2):464-470.
Perez D, Melling N, Biebl M, et al. Robotic low anterior resection versus transanal total mesorectal excision in rectal cancer: a comparison of 115 cases. Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2018;44(2):237-242.
Baukloh JK, Reeh M, Spinoglio G, et al. Evaluation of the robotic approach concerning pitfalls in rectal surgery. Eur J Surg Oncol. 2017;43(7):1304-1311.
Persiani R, Biondi A, Pennestri F, et al. Transanal total mesorectal excision vs laparoscopic total mesorectal excision in the treatment of low and middle rectal cancer: a propensity score matching analysis. Dis colon rectum. 2018;61(7):809-816.
Kapiteijn E, van de Velde CJ. The role of total mesorectal excision in the management of rectal cancer. Surg Clin N. Am. 2002;82(5):995-1007.
Jeong SY, Park JW, Nam BH, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(7):767-774.
Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922-928.
Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol. 2012;13(9):e403-408.
Keane C, Wells C, O'Grady G, Bissett IP. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis. 2017;19(8):713-722.
Sturiale A, Martellucci J, Zurli L, et al. Long-term functional follow-up after anterior rectal resection for cancer. Int J colorectal Dis. 2017;32(1):83-88.
Hupkens BJP, Breukink SO, Olde Reuver Of Briel C, et al. Dutch validation of the low anterior resection syndrome score. Colorectal Dis. 2018;20(10):881-887.
Denost Q, Laurent C, Capdepont M, Zerbib F, Rullier E. Risk factors for fecal incontinence after intersphincteric resection for rectal cancer. Dis colon rectum. 2011;54(8):963-968.
Rosen HR, Kneist W, Furst A, Kramer G, Hebenstreit J, Schiemer JF. Randomized clinical trial of prophylactic transanal irrigation versus supportive therapy to prevent symptoms of low anterior resection syndrome after rectal resection. BJS open. 2019;3(4):461-465.
Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane database Syst Rev. 2012;7:CD002111.
Schwandner O. Sacral neuromodulation for fecal incontinence and "low anterior resection syndrome" following neoadjuvant therapy for rectal cancer. Int J Colorectal Dis. 2013;28(5):665-669.
D'Annibale A, Pernazza G, Monsellato I, et al. Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc. 2013;27(6):1887-1895.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006-1012.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603-605.
Bondeven P, Emmertsen KJ, Laurberg S, Pedersen BG. Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery. Eur J Surg Oncol. 2015;41(11):1493-1499.
Pieniowski EHA, Palmer GJ, Juul T, et al. Low anterior resection syndrome and quality of life after sphincter-sparing rectal cancer surgery: a long-term longitudinal follow-up. Dis colon rectum. 2019;62(1):14-20.
Battersby NJ, Bouliotis G, Emmertsen KJ, et al. Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score. Gut. 2018;67(4):688-696.
Chen TY, Wiltink LM, Nout RA, et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin colorectal cancer. 2015;14(2):106-114.
Hain E, Manceau G, Maggiori L, Mongin C, Prost AlDJ, Panis Y. Bowel dysfunction after anastomotic leakage in laparoscopic sphincter-saving operative intervention for rectal cancer: a case-matched study in 46 patients using the Low Anterior Resection Score. Surgery. 2017;161(4):1028-1039.
Ihnat P, Slivova I, Tulinsky L, Ihnat Rudinska L, Maca J, Penka I. Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study). J Surg Oncol. 2018;117(4):710-716.
Nuytens F, Develtere D, Sergeant G, Parmentier I, D'Hoore A, D'Hondt M. Perioperative radiotherapy is an independent risk factor for major LARS: a cross-sectional observational study. Int J colorectal Dis. 2018;33(8):1063-1069.
Lim RS, Yang TX, Chua TC. Postoperative bladder and sexual function in patients undergoing surgery for rectal cancer: a systematic review and meta-analysis of laparoscopic versus open resection of rectal cancer. Tech coloproctology. 2014;18(11):993-1002.
Kneist W, Wachter N, Paschold M, Kauff DW, Rink AD, Lang H. Midterm functional results of taTME with neuromapping for low rectal cancer. Tech Coloproctology. 2016;20(1):41-49.
Denost Q, Adam JP, Rullier A, Buscail E, Laurent C, Rullier E. Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg. 2014;260(6):993-999.
Lim DR, Bae SU, Hur H, et al. Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc. 2017;31(4):1728-1737.
Sun W, Dou R, Chen J, et al. Impact of long-course neoadjuvant radiation on postoperative low anterior resection syndrome and quality of life in rectal cancer: post Hoc analysis of a randomized controlled trial. Ann Surg Oncol. 2019;26(3):746-755.
Kupsch J, Jackisch T, Matzel KE, et al. Outcome of bowel function following anterior resection for rectal cancer-an analysis using the low anterior resection syndrome (LARS) score. Int J colorectal Dis. 2018;33(6):787-798.
Qin Q, Huang B, Cao W, et al. Bowel dysfunction after low anterior resection with neoadjuvant chemoradiotherapy or chemotherapy alone for rectal cancer: a cross-sectional study from China. Dis Colon Rectum. 2017;60(7):697-705.
Beppu N, Kimura H, Matsubara N, Tomita N, Yanagi H, Yamanaka N. Long-term functional outcomes of total mesorectal excision following chemoradiotherapy for lower rectal cancer: stapled anastomosis versus intersphincteric resection. Dig Surg. 2016;33(1):33-42.
Emmertsen KJ, Laurberg S, Rectal Cancer Function Study G. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg. 2013;100(10):1377-1387.
Juul T, Battersby NJ, Christensen P, et al. Validation of the English translation of the low anterior resection syndrome score. Colorectal Dis. 2015;17(10):908-916.
Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, Sangkhathat S. Factors determining low anterior resection syndrome after rectal cancer resection: a study in Thai patients. Asian J Surg. 2016;39(4):225-231.
Tan SH, Liao YM, Lee KC, Ko YL, Lin PC. Exploring bowel dysfunction of patients following colorectal surgery: a cohort study. J Clin Nurs. 2019;28(9-10):1577-1584.
Samalavicius NE, Dulskas A, Lasinskas M, Smailyte G. Validity and reliability of a Lithuanian version of low anterior resection syndrome score. Tech coloproctology. 2016;20(4):215-220.
Hughes DL, Cornish J, Morris C, Group LTM. Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome. Int J colorectal Dis. 2017;32(5):691-697.
Juul T, Ahlberg M, Biondo S, et al. International validation of the low anterior resection syndrome score. Ann Surg. 2014;259(4):728-734.
Bregendahl S, Emmertsen KJ, Lous J, Laurberg S. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis. 2013;15(9):1130-1139.
Pietrzak L, Bujko K, Nowacki MP, et al. Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiotherapy Oncol. 2007;84(3):217-225.
Ngan SY, Burmeister B, Fisher RJ, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol. 2012;30(31):3827-3833.
Luca F, Valvo M, Guerra-Cogorno M, et al. Functional results of robotic total intersphincteric resection with hand-sewn coloanal anastomosis. Eur J Surg Oncol. 2016;42(6):841-847.
Rahbari NN, Elbers H, Askoxylakis V, et al. Neoadjuvant radiotherapy for rectal cancer: meta-analysis of randomized controlled trials. Ann Surg Oncol. 2013;20(13):4169-4182.
Peeters KC, Marijnen CA, Nagtegaal ID, et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007;246(5):693-701.
De Caluwe L, Van Nieuwenhove Y, Ceelen WP. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev. 2013;(2):CD006041. doi:10.1002/14651858.CD006041.pub3
Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012;99(7):918-928.
Zorcolo L, Rosman AS, Restivo A, et al. Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: a meta-analysis. Ann Surg Oncol. 2012;19(9):2822-2832.
Ribas Y, Aguilar F, Jovell-Fernandez E, Cayetano L, Navarro-Luna A, Munoz-Duyos A. Clinical application of the LARS score: results from a pilot study. Int J colorectal Dis. 2017;32(3):409-418.
Yoo RN, Cho HM, Kye BH, Kim HJ, Shin S, Kim G. Rapid transit in the left-sided colon is related to poor defecatory function at early period after stoma closure. Sci Rep. 2020;10(1):3739.
Juul T, Elfeki H, Christensen P, Laurberg S, Emmertsen KJ, Bager P. Normative data for the low anterior resection syndrome score (LARS score). Ann Surg. 2019;269(6):1124-1128.
Sakr A, Sauri F, Alessa M, et al. Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer. Chin Med J (Engl). 2020;133(15):1824-1833.
Joye I, Haustermans K. Clinical target volume delineation for rectal cancer radiation therapy: time for updated guidelines? Int J Radiat Oncol Biol Phys. 2015;91(4):690-691.
Akizuki E, Matsuno H, Satoyoshi T, et al. Validation of the Japanese version of the low anterior resection syndrome score. World J Surg. 2018;42(8):2660-2667.
Gadan S, Floodeen H, Lindgren R, Matthiessen P. Does a defunctioning stoma impair anorectal function after low anterior resection of the rectum for cancer? A 12-year follow-up of a randomized multicenter trial. Dis colon rectum. 2017;60(8):800-806.
Keane C, Park J, Oberg S, et al. Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg. 2019;106(5):645-652.
Trenti L, Galvez A, Biondo S, et al. Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: a cross-sectional study. Eur J Surg Oncol. 2018;44(7):1031-1039.
Rubinkiewicz M, Zarzycki P, Czerwinska A, et al. A quest for sphincter-saving surgery in ultralow rectal tumours-a single-centre cohort study. World J Surg Oncol. 2018;16(1):218.
Keller DS, Reali C, Spinelli A, et al. Patient-reported functional and quality-of-life outcomes after transanal total mesorectal excision. Br J Surg. 2019;106(4):364-366.
Koedam TW, van Ramshorst GH, Deijen CL, et al. Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech coloproctology. 2017;21(1):25-33.
Bjoern MX, Nielsen S, Perdawood SK. Quality of life after surgery for rectal cancer: a comparison of functional outcomes after transanal and laparoscopic approaches. J Gastrointest Surg. 2019;23(8):1623-1630.
Pontallier A, Denost Q, Van Geluwe B, Adam JP, Celerier B, Rullier E. Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc. 2016;30(11):4924-4933.
Rubinkiewicz M, Zarzycki P, Witowski J, et al. Functional outcomes after resections for low rectal tumors: comparison of Transanal with laparoscopic Total Mesorectal excision. BMC Surg. 2019;19(1):79.
Veltcamp Helbach M, Koedam TWA, Knol JJ, et al. Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc. 2019;33(1):79-87.