Comparison of perioperative complications and oncological results of transanal total mesorectal excision and robot assisted total mesorectal excision / 国际外科学杂志

ABSTRACT

Objective:To explore the perioperative safety and oncological results of laparoscopic assisted transanal total mesorectal excision (TaTME) and robot assisted total mesorectal excision (TME) in radical resection of low rectal cancer.Methods:A single center retrospective study was conducted. Analyzed the clinical data of 54 patients with low rectal cancer who received robot assisted TME or laparoscopic assisted TaTME in the first hospital of Jilin University from January 2020 to July 2022, including 39 males and 15 females, with a median age of 61 years old. They were divided into robot assisted TME group ( n=29) and laparoscope assisted TaTME group ( n=25) according to the surgical methods. Follow-up was carried out through outpatient, telephone and wechat. The follow-up time was 30 days after operation. The quality of mesorectal excision was divided into high quality and low quality according to the evaluation of the integrity of the mesentery of the specimen after total mesorectal excision and the circumferential cutting edge. The primary outcome was the quality of mesorectal excision, and the secondary end points were surgery related information, postoperative pathological information, and postoperative complications. SPSS25.0 software was used for statistical analysis. The measurement data of skew distribution were expressed by M( Q1, Q3), and the Mann Whitney U test was used for comparison between groups. The counting data were expressed by n(%), and the comparison between groups was conducted by χ2 test or Fisher exact probability method. Results:The high-quality mesorectal excision rate in TaTME group was 88% (22 cases), and the high-quality mesorectal excision rate in robot group was 100%, with no statistical difference( χ2=3.69, P=0.093). The operation time of TaTME group and robot assisted TME group was [180 (165, 220)] min and [140 (117, 168)] min, respectively, with statistical significance ( U=125.00, P<0.001). The preventive ileostomy rate was 100% in the TaTME group and 37.9% in the robot group( χ2=23.27, P<0.001). Compared with TaTME group, robot assisted TME had a longer distance from the lower tumor to the distal cutting edge [10 (5, 25) mm vs 35 (21, 41) mm, U=117.00, P<0.001], a longer distance from the deepest tumor to the circumferential cutting edge [15 (10, 25) mm vs 25 (20, 34) mm, U=165.50, P=0.003], and a larger tumor maximum meridian [20 (4, 52) mm vs 42 (30, 48) mm, U=202.50, P=0.005]. The total incidence of complications within 30 days after operation was 16.7%, of which the incidence of Clavien-Dindo Ⅰ to Ⅱ complications was 11.1%, and the incidence of Clavien-Dindo ⅢA complications was 5.6%. The overall complication rate of TaTME group was higher, but there was no significant difference (20.0% vs 13.8%, χ2=0.37, P=0.718). Conclusion:Both TaTME and robot assisted TME can ensure good quality of TME operation and can be used as an effective and safe treatment for low rectal cancer. When performing TaTME surgery for low rectal cancer, it is more necessary to ensure sufficient distal margin distance.