Integrating a tumour appropriate transanal or robotic assisted approach to total mesorectal excision in high-volume rectal cancer practice is safe and cost-effective.
Cost analysis
Robotic TME
Total mesorectal excision
Transanal TME
Journal
Journal of robotic surgery
ISSN: 1863-2491
Titre abrégé: J Robot Surg
Pays: England
ID NLM: 101300401
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
07
07
2022
accepted:
11
03
2023
medline:
11
9
2023
pubmed:
26
4
2023
entrez:
26
4
2023
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 37099264
doi: 10.1007/s11701-023-01577-z
pii: 10.1007/s11701-023-01577-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1979-1987Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.
Références
Heald R (1988) The ‘Holy Plane’ of rectal surgery. Jouornal R Soc Med 81(9):503–508
doi: 10.1177/014107688808100904
Heald RJ, Moran BJ, Ryall RD, Sexton R (1998) Rectal cancer: the basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133(8):894–899
doi: 10.1001/archsurg.133.8.894
pubmed: 9711965
Summary E (2018) The 2017 European Society of Coloproctology (ESCP) international snapshot audit of left colon, sigmoid and rectal resections—executive summary. Colorectal Dis 20:13–14
doi: 10.1111/codi.14391
Stevenson ARL et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA J Am Med Assoc 314(13):1356–1363
doi: 10.1001/jama.2015.12009
Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, Choi HS, Kim DW, Chang HJ, Kim DY, Jung KH, Kim TY, Kang GH, Chie EK, Kim SY, Sohn DK, Kim DH, Kim JS, Lee HS, Kim JH (2014) 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 15(7):767–774
doi: 10.1016/S1470-2045(14)70205-0
pubmed: 24837215
Fleshman J, Branda M, Sargent DJ et al (2015) Effect of laparoscopic- assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA J Am Med Assoc 314(32):1346–1355
doi: 10.1001/jama.2015.10529
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Lancet 365(9472):1728–1726
doi: 10.1016/S0140-6736(05)66545-2
Kang SB, Ji WP, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645
doi: 10.1016/S1470-2045(10)70131-5
pubmed: 20610322
van der Pas M, Haglind E, Cuesta M et al (2013) COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(03):210–218
doi: 10.1016/S1470-2045(13)70016-0
pubmed: 23395398
YP Rose Khavari Nicholas Dias (2017) Disease free survival and local recurrence for laparoscopic resection compared to open resection of stage II-III Rectal cancer: follow up results of the ACOSOG Z6051 randomized controlled trial. Physiol Behav 176(3):139–148
Park J et al (2021) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): 10-year follow-up of an open-label, non-inferiority, randomised controlled trial. Lancet Gastroenterol ad Hepatol 6(7):569–577
doi: 10.1016/S2468-1253(21)00094-7
Jayne D et al (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 J Am Med Assoc 318(16):1569–1580
doi: 10.1001/jama.2017.7219
Corrigan N, Marshall H, Croft J, Copeland J, Jayne D, Brown J (2018) Exploring and adjusting for potential learning effects in ROLARR: a randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection. Trials 19(1):1–11
doi: 10.1186/s13063-018-2726-0
Kim MJ et al (2018) Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg 267(2):243–251
doi: 10.1097/SLA.0000000000002321
pubmed: 28549014
Larsen SG, Pfeffer F, Kørner H (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg 106(9):1120–1121
doi: 10.1002/bjs.11287
pubmed: 31304578
Fearnhead NS et al (2020) The ACPGBI recommends pause for reflection on transanal total mesorectal excision. Color Dis 22(7):745–748
doi: 10.1111/codi.15143
Harji D et al (2021) The feasibility of implementing an enhanced recovery programme in patients undergoing pelvic exenteration. Eur J Surg Oncol 47(12):3194–3201
doi: 10.1016/j.ejso.2021.07.013
pubmed: 34736803
McLemore EC, Lavi P, Attaluri V (2020) Learning transanal total mesorectal excision. Clin Colon Rectal Surg 33(3):168–172
doi: 10.1055/s-0039-3402779
pubmed: 32351340
pmcid: 7188506
L’Etude Nationale des Coûts (ENC) MCO (2018) Available at: https://www.atih.sante.fr/information-sur-lescouts/etudes-nationales-de-couts-presentation-et-recrutement . Accessed 01 May 2022
Kim JY, Kim YW, Kim NK et al (2011) Pelvic anatomy as a factor in laparoscopic rectal surgery: a prospective study. Surg Laparosc Endosc Percutan Tech. 21:334–339
doi: 10.1097/SLE.0b013e31822cf8bc
pubmed: 22002269
Jayne DG et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3 Year results of the UK MRC CLASICC trial group. J Clin Oncol 25(21):3061–3068
doi: 10.1200/JCO.2006.09.7758
pubmed: 17634484
Parascandola SA et al (2021) The robotic colorectal experience: an outcomes and learning curve analysis of 502 patients. Color Dis 23(1):226–236
doi: 10.1111/codi.15398
Adamina M et al (2020) International expert consensus guidance on indications, implementation and quality measures for transanal total mesorectal excision. Color Dis 22(7):749–755
doi: 10.1111/codi.15147
Prete FP et al (2018) Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg 267(6):1034–1046
doi: 10.1097/SLA.0000000000002523
pubmed: 28984644
Lee SH, Kim DH, Lim SW (2018) Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 33(12):1741–1753
doi: 10.1007/s00384-018-3145-0
pubmed: 30187156
Yuan DB, Wen XN, Xu XC, Li T (2012) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. World Chinese J Dig 20(36):3804–3810
doi: 10.11569/wcjd.v20.i36.3804
Fleming CA, Cullinane C, Lynch N, Killeen S, Coffey JC, Peirce CB (2021) Urogenital function following robotic and laparoscopic rectal cancer surgery: meta-analysis. Br J Surg 108(2):128–137
doi: 10.1093/bjs/znaa067
pubmed: 33711141
Luca F et al (2018) Sexual and urinary outcomes in robotic rectal surgery: review of the literature and technical considerations. Updates Surg 70(3):415–421
doi: 10.1007/s13304-018-0581-x
pubmed: 30120743
Deleon MF, Maloney Patel N (2015) RC “Robotic colorectal surgery: outcomes and cost analysis at a single institution.” In: American Society of Colon and Rectal Surgeons Annual Scientific Meeting. p MA2015
Deleon MF, Maloney Patel N (2016) “Robotic surgery for diverticulitis—is it cost effective?” In: American Society of Colon and Rectal Surgeons Annual Scientific Meeting. CA2016.
Rouanet P, Mermoud A, Jarlier M, Bouazza N, Laine A, Mathieu Daudé H (2020) Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy. BJS open. 4(3):516–523
doi: 10.1002/bjs5.50281
pubmed: 32352227
pmcid: 7260409
Carmichael H, Sylla P (2020) Evolution of transanal total mesorectal excision. Clin Colon Rectal Surg 33(3):113–127
doi: 10.1055/s-0039-3402773
pubmed: 32351334
pmcid: 7188508
Burghgraef TA et al (2021) Laparoscopic versus robot-assisted versus transanal low anterior reseion: 3 year oncologic results for a population-based cohort in experienced centers. Ann Surg Oncol 29(3):1910–1920
doi: 10.1245/s10434-021-10805-5
pubmed: 34608557
pmcid: 8810464
van der Heijden JAG et al (2020) Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis. Br J Surg 107(5):489–498
doi: 10.1002/bjs.11566
pubmed: 32154594
Koedam TWA et al (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol 21(1):25–33
doi: 10.1007/s10151-016-1570-z
pubmed: 28044239
pmcid: 5285410
Roodbeen SX et al (2021) Local recurrence and disease-free survival after transanal total mesorectal excision: results from the international TaTME registry. JNCCN J Natl Compr Cancer Netw 19(11):1232–1240
doi: 10.6004/jnccn.2021.7012
Miskovic D et al (2019) European consensus on the standardization of robotic total mesorectal excision for rectal cancer. Color Dis 21(3):270–276
doi: 10.1111/codi.14502
Tou S et al (2020) European expert consensus on a structured approach to training robotic-assisted low anterior resection using performance metrics. Color Dis 22(12):2232–2242
doi: 10.1111/codi.15269
Rouanet P et al (2019) Rectal Surgery Evaluation Trial: protocol for a parallel cohort trial of outcomes using surgical techniques for total mesorectal excision with low anterior resection in high-risk rectal cancer patients. Color Dis 21(5):516–522
doi: 10.1111/codi.14581