Filippos Sagias
INTRODUCTION: Robotic surgery can overcome
some limitations of Laparoscopic Total Mesorectal Excision
(L-TME), improving the quality of the surgery. We
aim to compare the medium-term oncological outcomes
of L-TME vs. Robotic Total Mesorectal Excision (R-TME)
for rectal cancer. METHODS A retrospective analysis was
performed including patients who underwent L-TME
or R-TME between 2011-2017. Patients presenting with
metastatic disease or R1 resection were excluded. From a
total of 680 patients, 136 cases of R-TME were matched
based on age, gender, stage and time of follow-up with
an equal number of patients who underwent L-TME.
We compared 3-year disease free survival (DFS) and overall
survival (OS). RESULTS Major complications were
lower in the robotic group (13.2% vs. 22.8%, p=0.04),
highlighting the anastomotic leakage rate (7.4% vs.
16.9%, p=0.01). The 3-year DFS rate for all stages was
69% for L-TME and 84% for R-TME (p=0.02). For disease
stage III, 3-year DFS was significantly higher in the
R-TME group. OS was also significantly superior in the
robotic group for every stage, reaching 86% in stage III.
In the multivariate analysis, R-TME was a significant
positive prognostic factor for distant metastasis (OR 0.2
95%CI 0.1, 0.6, p=0.001) and OS (OR 0.2 95%CI 0.07,
0.4, p=0.000). Moreover, major complications were also
found to have a negative impact on OS (OR 8.3 95%
CI 3.2, 21.6, p=0.000). CONCLUSION R-TME for rectal
cancer can achieve better oncological outcomes compared
to L-TME, especially in stage III rectal cancers.