Abstract
BackgroundTotal mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation.MethodsThis is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months.ResultsUpon multivariate analysis, histologic grade (P = 0.016), and stage (P < 0.001) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P < 0.05). Multivariable analyses observed the surgical method (P = 0.037), histologic grade (P = 0.006), and CRM involvement (P = 0.043) were the independent factors of DFS, whereas histologic grade (P = 0.011) and pathologic stage (P = 0.022) were the independent prognostic variables of OS.ConclusionsThis study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.
Highlights
Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC)
Clinicopathological factors and postoperative outcomes of different surgical methods Overall, 300 consecutive patients with RC were enrolled in this study, which included 88 patients who underwent robotic surgery, 37 who underwent laparoscopic surgery, and the remaining 175 patients who underwent open surgery (Fig. 1)
The distance to proximal or distal resection margins, TME completeness status, and retrieved lymph node number were evaluated by pathologists
Summary
Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). The conventional treatment for RC might involve total mesorectal excision (TME) combined with preoperative neoadjuvant. With the availability of modern medical facilities and the advancement in surgical techniques, minimallyinvasive surgery has garnered the reputation of being the ideal treatment compared with open surgery. Besides the conventional laparoscopic surgery (LS), the roboticassisted surgery (RS) has gradually become an accepted surgical technique that is considered advantageous. Several large, multicenter randomized control studies had only compared LS with open surgery regarding surgery for RC, with findings showing more CRM involvement rates, worse sexual function, and worse prognosis [7]. Given the increasing number of RS with reportedly favorable CRM involvement [8], the oncological outcomes of these three different surgical methods are still to be defined
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