Efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision for rectal cancer: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Yuan ,  SHEN Wei , TIAN Zhiqiang , ZHANG Yinchao , TAO Guoqing , ZHU Yanfei , SONG Guodong , CAO Jiacheng , HUANG Yukang , SONG Chen

Department of General Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, P. R. China;

Corresponding author：

SHEN Wei, Email: shenweijs@outlook.com

Keywords：

Total rectal mesenteric resection; Laparoscopic; Robotic; Open surgery; Cohort study; Network meta-analysis

DOI：

10.7507/1672-2531.202205147

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision (TME) for the treatment of rectal cancer. Methods The PubMed, EMbase, The Cochrane Library, and ClinicalTrials.gov databases were electronically searched to identify cohort studies on robotic, laparoscopic-assisted, and open TME for rectal cancer published from January 2016 to January 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Subsequently, network meta-analysis was performed using RevMan 5.4 software and R software. Results A total of 24 studies involving 12 348 patients were included. The results indicated that among the three types of surgical procedures, robotic TME showed the best outcomes by shortening the length of hospital stay, reducing the incidence of postoperative anastomotic fistula and intestinal obstruction, and lowering the overall postoperative complication rate. However, differences in the number of dissected peritumoural lymph nodes were not statistically significant. Conclusion Robotic TME shows better outcomes in terms of the radicality of excision and postoperative short-term outcomes in the treatment of rectal cancer. However, clinicians should consider the patients’ actual condition for the selection of surgical methods to achieve individualised treatment for patients with rectal cancer.

Citation： LIU Yuan, SHEN Wei, TIAN Zhiqiang, ZHANG Yinchao, TAO Guoqing, ZHU Yanfei, SONG Guodong, CAO Jiacheng, HUANG Yukang, SONG Chen. Efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision for rectal cancer: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(10): 1134-1141. doi: 10.7507/1672-2531.202205147 Copy

1.	雷伟琦. 机器人与腹腔镜手术在治疗直肠癌全系膜切除术近期疗效对比Meta分析. 南昌: 南昌大学, 2016.
2.	Allaix ME, Giraudo G, Ferrarese A, et al. 10-year oncologic outcomes after laparoscopic or open total mesorectal excision for rectal cancer. World J Surg, 2016, 40(12): 3052-3062.
3.	Bedrikovetski S, Dudi-Venkata NN, Kroon HM, et al. Outcomes of minimally invasive versus open proctectomy for rectal cancer: a propensity-matched analysis of Bi-national colorectal cancer audit data. Dis Colon Rectum, 2020, 63(6): 778-787.
4.	Burghgraef TA, Crolla RMPH, Verheijen PM, et al. Robot-assisted total mesorectal excision versus laparoscopic total mesorectal excision: a retrospective propensity score-matched cohort analysis in experienced centers. Dis Colon Rectum, 2022, 65(2): 218-227.
5.	Chen W, Li Q, Qiu P, et al. Comparison of perioperative outcomes between laparoscopic and open surgery for mid-low rectal cancer with total mesorectal excision following neoadjuvant chemoradiotherapy. J Cancer Res Ther, 2016, 12(Supplement): C199-C204.
6.	Chen YT, Kiu KT, Yen MH, et al. Comparison of the short-term outcomes in lower rectal cancer using three different surgical techniques: transanal total mesorectal excision (TME), laparoscopic TME, and open TME. Asian J Surg, 2019, 42(6): 674-680.
7.	Colombo PE, Bertrand MM, Alline M, et al. Robotic versus laparoscopic total mesorectal excision (TME) for sphincter-saving surgery: is there any difference in the transanal TME rectal approach: a single-center series of 120 consecutive patients. Ann Surg Oncol, 2016, 23(5): 1594-1600.
8.	Esen E, Aytac E, Ağcaoğlu O, et al. Totally robotic versus totally laparoscopic surgery for rectal cancer. Surg Laparosc Endosc Percutan Tech, 2018, 28(4): 245-249.
9.	Hol JC, Burghgraef TA, Rutgers MLW, et al. Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer: a retrospective propensity score-matched cohort study of short-term outcomes. Br J Surg, 2021, 108(11): 1380-1387.
10.	Kim HJ, Choi GS, Park JS, et al. The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity score-matched analysis with laparoscopic surgery. Colorectal Dis, 2018, 20(5): 103-113.
11.	Kim JC, Yu CS, Lim SB, et al. Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted, and robot-assisted approaches in rectal cancer patients. Int J Colorectal Dis, 2016, 31(6): 1179-1187.
12.	Law WL, Foo DCC. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer. Surg Endosc, 2017, 31(7): 2798-2807.
13.	Liu WH, Yan PJ, Hu DP, et al. Short-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: a cohort study. Am Surg, 2019, 85(3): 294-302.
14.	Liu Y, Lu X, Niu Y, et al. Application of laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal cancer. J Innov Opt Health Sci, 2016, 9(5): 1643002.
15.	Morelli L, Guadagni S, Lorenzoni V, et al. Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon's experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si. Int J Colorectal Dis, 2016, 31(9): 1639-1648.
16.	Nonaka T, Fukuda A, Maekawa K, et al. Clinical and oncological outcomes of laparoscopic lateral pelvic lymph node dissection in advanced lower rectal cancer: single-institution experience. Anticancer Res, 2017, 37(9): 5095-5100.
17.	Ose I, Perdawood SK. A nationwide comparison of short-term outcomes after transanal, open, laparoscopic, and robot-assisted total mesorectal excision. Colorectal Dis, 2021, 23(10): 2671-2680.
18.	Park CH, Bae SU, Jeong WK, et al. Early and late clinico-pathologic outcomes of minimally invasive total mesorectal excision for rectal cancer: a propensity score-matched comparison of robotic and laparoscopic approaches. Int J Med Robot, 2021, 17(6): e2324.
19.	Ramji KM, Cleghorn MC, Josse JM, et al. Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center. Surg Endosc, 2016, 30(4): 1337-1343.
20.	Rouanet P, Bertrand MM, Jarlier M, et al. Robotic versus laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol, 2018, 25(12): 3572-3579.
21.	Sugoor P, Verma K, Chaturvedi A, et al. Robotic versus laparoscopic sphincter-preserving total mesorectal excision: a propensity case-matched analysis. Int J Med Robot, 2019, 15(1): e1965.
22.	Tejedor P, Sagias F, Flashman K, et al. The impact of robotic total mesorectal excision on survival of patients with rectal cancer-a propensity matched analysis. Int J Colorectal Dis, 2019, 34(12): 2081-2089.
23.	Wang Y, Li Z, Yi B, et al. Initial experience of Chinese surgical robot "Micro Hand S″-assisted versus open and laparoscopic total mesorectal excision for rectal cancer: short-term outcomes in a single center. Asian J Surg, 2022, 45(1): 299-306.
24.	Wang Y, Wang G, Li Z, et al. Comparison of the operative outcomes and learning curves between laparoscopic and "Micro Hand S" robot-assisted total mesorectal excision for rectal cancer: a retrospective study. BMC Gastroenterol, 2021, 21(1): 251.
25.	Yamaguchi T, Konishi T, Kinugasa Y, et al. Laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer: a subgroup analysis of a large multicenter cohort study in Japan. Dis Colon Rectum, 2017, 60(9): 954-964.
26.	Yamaguchi T, Kinugasa Y, Shiomi A, et al. Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc, 2018, 32(11): 4498-4505.

1. 雷伟琦. 机器人与腹腔镜手术在治疗直肠癌全系膜切除术近期疗效对比Meta分析. 南昌: 南昌大学, 2016.
2. Allaix ME, Giraudo G, Ferrarese A, et al. 10-year oncologic outcomes after laparoscopic or open total mesorectal excision for rectal cancer. World J Surg, 2016, 40(12): 3052-3062.
3. Bedrikovetski S, Dudi-Venkata NN, Kroon HM, et al. Outcomes of minimally invasive versus open proctectomy for rectal cancer: a propensity-matched analysis of Bi-national colorectal cancer audit data. Dis Colon Rectum, 2020, 63(6): 778-787.
4. Burghgraef TA, Crolla RMPH, Verheijen PM, et al. Robot-assisted total mesorectal excision versus laparoscopic total mesorectal excision: a retrospective propensity score-matched cohort analysis in experienced centers. Dis Colon Rectum, 2022, 65(2): 218-227.
5. Chen W, Li Q, Qiu P, et al. Comparison of perioperative outcomes between laparoscopic and open surgery for mid-low rectal cancer with total mesorectal excision following neoadjuvant chemoradiotherapy. J Cancer Res Ther, 2016, 12(Supplement): C199-C204.
6. Chen YT, Kiu KT, Yen MH, et al. Comparison of the short-term outcomes in lower rectal cancer using three different surgical techniques: transanal total mesorectal excision (TME), laparoscopic TME, and open TME. Asian J Surg, 2019, 42(6): 674-680.
7. Colombo PE, Bertrand MM, Alline M, et al. Robotic versus laparoscopic total mesorectal excision (TME) for sphincter-saving surgery: is there any difference in the transanal TME rectal approach: a single-center series of 120 consecutive patients. Ann Surg Oncol, 2016, 23(5): 1594-1600.
8. Esen E, Aytac E, Ağcaoğlu O, et al. Totally robotic versus totally laparoscopic surgery for rectal cancer. Surg Laparosc Endosc Percutan Tech, 2018, 28(4): 245-249.
9. Hol JC, Burghgraef TA, Rutgers MLW, et al. Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer: a retrospective propensity score-matched cohort study of short-term outcomes. Br J Surg, 2021, 108(11): 1380-1387.
10. Kim HJ, Choi GS, Park JS, et al. The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity score-matched analysis with laparoscopic surgery. Colorectal Dis, 2018, 20(5): 103-113.
11. Kim JC, Yu CS, Lim SB, et al. Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted, and robot-assisted approaches in rectal cancer patients. Int J Colorectal Dis, 2016, 31(6): 1179-1187.
12. Law WL, Foo DCC. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer. Surg Endosc, 2017, 31(7): 2798-2807.
13. Liu WH, Yan PJ, Hu DP, et al. Short-term outcomes of robotic versus laparoscopic total mesorectal excision for rectal cancer: a cohort study. Am Surg, 2019, 85(3): 294-302.
14. Liu Y, Lu X, Niu Y, et al. Application of laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal cancer. J Innov Opt Health Sci, 2016, 9(5): 1643002.
15. Morelli L, Guadagni S, Lorenzoni V, et al. Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon's experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si. Int J Colorectal Dis, 2016, 31(9): 1639-1648.
16. Nonaka T, Fukuda A, Maekawa K, et al. Clinical and oncological outcomes of laparoscopic lateral pelvic lymph node dissection in advanced lower rectal cancer: single-institution experience. Anticancer Res, 2017, 37(9): 5095-5100.
17. Ose I, Perdawood SK. A nationwide comparison of short-term outcomes after transanal, open, laparoscopic, and robot-assisted total mesorectal excision. Colorectal Dis, 2021, 23(10): 2671-2680.
18. Park CH, Bae SU, Jeong WK, et al. Early and late clinico-pathologic outcomes of minimally invasive total mesorectal excision for rectal cancer: a propensity score-matched comparison of robotic and laparoscopic approaches. Int J Med Robot, 2021, 17(6): e2324.
19. Ramji KM, Cleghorn MC, Josse JM, et al. Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center. Surg Endosc, 2016, 30(4): 1337-1343.
20. Rouanet P, Bertrand MM, Jarlier M, et al. Robotic versus laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol, 2018, 25(12): 3572-3579.
21. Sugoor P, Verma K, Chaturvedi A, et al. Robotic versus laparoscopic sphincter-preserving total mesorectal excision: a propensity case-matched analysis. Int J Med Robot, 2019, 15(1): e1965.
22. Tejedor P, Sagias F, Flashman K, et al. The impact of robotic total mesorectal excision on survival of patients with rectal cancer-a propensity matched analysis. Int J Colorectal Dis, 2019, 34(12): 2081-2089.
23. Wang Y, Li Z, Yi B, et al. Initial experience of Chinese surgical robot "Micro Hand S″-assisted versus open and laparoscopic total mesorectal excision for rectal cancer: short-term outcomes in a single center. Asian J Surg, 2022, 45(1): 299-306.
24. Wang Y, Wang G, Li Z, et al. Comparison of the operative outcomes and learning curves between laparoscopic and "Micro Hand S" robot-assisted total mesorectal excision for rectal cancer: a retrospective study. BMC Gastroenterol, 2021, 21(1): 251.
25. Yamaguchi T, Konishi T, Kinugasa Y, et al. Laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer: a subgroup analysis of a large multicenter cohort study in Japan. Dis Colon Rectum, 2017, 60(9): 954-964.
26. Yamaguchi T, Kinugasa Y, Shiomi A, et al. Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc, 2018, 32(11): 4498-4505.

Previous Article
The trend of muscle and tendon injuries in China from 2005 to 2019: an age-time-cohort analysis
Next Article
The rate of falls in Chinese elderly: a meta-analysis

Chinese Journal of Evidence-Based Medicine

Efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision for rectal cancer: a network meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content