Association of Surgical Approaches and Outcomes in Total Mesorectal Excision and Margin Status for Rectal Cancer

Despite being a key metric with a significant correlation with the outcomes of patients with rectal cancer, the optimal surgical approach for total mesorectal excision (TME) has not yet been identified. The aim of this study was to assess the association of the surgical approach on the quality of TM...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of surgical research 2024-08, Vol.300, p.494-502
Main Authors: Mirza, Muhammad Bilal, Gamboa, Adriana C., Irlmeier, Rebecca, Hopkins, Benjamin, Regenbogen, Scott E., Hrebinko, Katherine A., Holder-Murray, Jennifer, Wiseman, Jason T., Ejaz, Aslam, Wise, Paul E., Ye, Fei, Idrees, Kamran, Hawkins, Alexander T., Balch, Glen C., Khan, Aimal
Format: Article
Language:English
Subjects:
Laparoscopic surgery
Rectal cancer
Robotic surgery
Surgical margins
Survival outcomes
Total mesorectal excision
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c278t-65d38f4a02c2983db7cab08fd0f14b0784ae66f41b1407c973c4359b99df1bb63
container_end_page 502
container_issue
container_start_page 494
container_title The Journal of surgical research
container_volume 300
creator Mirza, Muhammad Bilal
Gamboa, Adriana C.
Irlmeier, Rebecca
Hopkins, Benjamin
Regenbogen, Scott E.
Hrebinko, Katherine A.
Holder-Murray, Jennifer
Wiseman, Jason T.
Ejaz, Aslam
Wise, Paul E.
Ye, Fei
Idrees, Kamran
Hawkins, Alexander T.
Balch, Glen C.
Khan, Aimal
description Despite being a key metric with a significant correlation with the outcomes of patients with rectal cancer, the optimal surgical approach for total mesorectal excision (TME) has not yet been identified. The aim of this study was to assess the association of the surgical approach on the quality of TME and surgical margins and to characterize the surgical and long-term oncologic outcomes in patients undergoing robotic, laparoscopic, and open TME for rectal cancer. Patients with primary, nonmetastatic rectal adenocarcinoma who underwent either lower anterior resection or abdominoperineal resection via robotic (Rob), laparoscopic (Lap), or open approaches were selected from the US Rectal Cancer Consortium database (2007-2017). Quasi-Poisson regression analysis with backward selection was used to investigate the relationship between the surgical approach and outcomes of interest. Among the 664 patients included in the study, the distribution of surgical approaches was as follows: 351 (52.9%) underwent TME via the open approach, 159 (23.9%) via the robotic approach, and 154 (23.2%) via the laparoscopic approach. There were no significant differences in baseline demographics among the three cohorts. The laparoscopic cohort had fewer patients with low rectal cancer (
doi_str_mv 10.1016/j.jss.2024.05.032
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3068755365</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022480424002920</els_id><sourcerecordid>3068755365</sourcerecordid><originalsourceid>FETCH-LOGICAL-c278t-65d38f4a02c2983db7cab08fd0f14b0784ae66f41b1407c973c4359b99df1bb63</originalsourceid><addsrcrecordid>eNp9kMFO4zAQhi20CLrAA3BBPu4lYRw7iSNOVVVYJBASLWfLcWxw1cbFk6x23x5HBY57mhnpm1_6P0IuGeQMWHW9yTeIeQGFyKHMgRdHZMagKTNZ1fwHmQEURSYkiFPyE3ED6W5qfkJOuZR12Qg5I_s5YjBeDz70NDi6GuOrN3pL5_t9DNq8WaS67-jTOJiwS4fv6ToMCXi0GKI107r8azxOARP5qFNCT1eDHkakLkT6fKAWujc2npNjp7doLz7nGXm5Xa4Xv7OHp7v7xfwhM0Uth6wqOy6d0FCYopG8a2ujW5CuA8dEC7UU2laVE6xlAmqTahnBy6Ztms6xtq34Gfl1yE013keLg9p5NHa71b0NIyoOVXJQ8qpMKDugJgbEaJ3aR7_T8Z9ioCbRaqOSaDWJVlCqJDr9XH3Gj-3Odt8fX2YTcHMAbCr5x9uo0HibDHR-sqa64P8T_wE2FI8Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3068755365</pqid></control><display><type>article</type><title>Association of Surgical Approaches and Outcomes in Total Mesorectal Excision and Margin Status for Rectal Cancer</title><source>ScienceDirect Freedom Collection 2022-2024</source><creator>Mirza, Muhammad Bilal ; Gamboa, Adriana C. ; Irlmeier, Rebecca ; Hopkins, Benjamin ; Regenbogen, Scott E. ; Hrebinko, Katherine A. ; Holder-Murray, Jennifer ; Wiseman, Jason T. ; Ejaz, Aslam ; Wise, Paul E. ; Ye, Fei ; Idrees, Kamran ; Hawkins, Alexander T. ; Balch, Glen C. ; Khan, Aimal</creator><creatorcontrib>Mirza, Muhammad Bilal ; Gamboa, Adriana C. ; Irlmeier, Rebecca ; Hopkins, Benjamin ; Regenbogen, Scott E. ; Hrebinko, Katherine A. ; Holder-Murray, Jennifer ; Wiseman, Jason T. ; Ejaz, Aslam ; Wise, Paul E. ; Ye, Fei ; Idrees, Kamran ; Hawkins, Alexander T. ; Balch, Glen C. ; Khan, Aimal</creatorcontrib><description>Despite being a key metric with a significant correlation with the outcomes of patients with rectal cancer, the optimal surgical approach for total mesorectal excision (TME) has not yet been identified. The aim of this study was to assess the association of the surgical approach on the quality of TME and surgical margins and to characterize the surgical and long-term oncologic outcomes in patients undergoing robotic, laparoscopic, and open TME for rectal cancer. Patients with primary, nonmetastatic rectal adenocarcinoma who underwent either lower anterior resection or abdominoperineal resection via robotic (Rob), laparoscopic (Lap), or open approaches were selected from the US Rectal Cancer Consortium database (2007-2017). Quasi-Poisson regression analysis with backward selection was used to investigate the relationship between the surgical approach and outcomes of interest. Among the 664 patients included in the study, the distribution of surgical approaches was as follows: 351 (52.9%) underwent TME via the open approach, 159 (23.9%) via the robotic approach, and 154 (23.2%) via the laparoscopic approach. There were no significant differences in baseline demographics among the three cohorts. The laparoscopic cohort had fewer patients with low rectal cancer (&lt;6 cm from the anal verge) than the robotic and open cohorts (Lap 28.6% versus Rob 59.1% versus Open 45.6%, P = 0.015). Patients who underwent Rob and Lap TME had lower intraoperative blood loss compared with the Open approach (Rob 200 mL [Q1, Q3: 100.0, 300.0] versus Lap 150 mL [Q1, Q3: 75.0, 250.0] versus Open 300 mL [Q1, Q3: 150.0, 600.0], P &lt; 0.001). There was no difference in the operative time (Rob 243 min [Q1, Q3: 203.8, 300.2] versus Lap 241 min [Q1, Q3: 186, 336] versus Open 226 min [Q1, Q3: 178, 315.8], P = 0.309) between the three approaches. Postoperative length of stay was shorter with robotic and laparoscopic approach compared to open approach (Rob 5.0 d [Q1, Q3: 4, 8.2] versus Lap 5 d [Q1, Q3: 4, 8] versus Open 7.0 d [Q1, Q3: 5, 9], P &lt; 0.001). There was no statistically significant difference in the quality of TME between the robotic, laparoscopic, and open approaches (79.2%, 64.9%, and 64.7%, respectively; P = 0.46). The margin positivity rate, a composite of circumferential margin and distal margin, was higher with the robotic and open approaches than with the laparoscopic approach (Rob 8.2% versus Open 6.6% versus Lap 1.9%, P = 0.17), Rob versus Lap (odds ratio 0.21; 95% confidence interval 0.05, 0.83) and Rob versus Open (odds ratio 0.5; 95% confidence interval 0.22, 1.12). There was no difference in long-term survival, including overall survival and recurrence-free survival, between patients who underwent robotic, laparoscopic, or open TME (Figure 1). In patients undergoing surgery with curative intent for rectal cancer, we did not observe a difference in the quality of TME between the robotic, laparoscopic, or open approaches. Robotic and open TME compared to laparoscopic TME were associated with higher margin positivity rates in our study. This was likely due to the higher percentage of low rectal cancers in the robotic and open cohorts. We also reported no significant differences in overall survival and recurrence-free survival between the aforementioned surgical techniques. •Optimal surgical approach for total mesorectal excision (TME) in rectal cancer remains unidentified.•Study reveals no significant differences in histopathological TME completeness, long-term outcomes (overall survival and recurrence-free survival), and overall TME quality between robotic and laparoscopic approaches in rectal cancer patients.•Higher margin positivity rates linked to robotic and open TME, potentially attributed to low rectal cancer cases in retrospective cohort.•Laparoscopic TME demonstrates lower intraoperative blood loss when compared to open surgical approach, robotic approach associated with fewer postoperative complications.•Robotic TME emerges as a safe and effective treatment option in rectal cancer surgery.•Large multicenter dataset analysis supports robust evidence-based practice in rectal cancer surgery.</description><identifier>ISSN: 0022-4804</identifier><identifier>ISSN: 1095-8673</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2024.05.032</identifier><identifier>PMID: 38875948</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Laparoscopic surgery ; Rectal cancer ; Robotic surgery ; Surgical margins ; Survival outcomes ; Total mesorectal excision</subject><ispartof>The Journal of surgical research, 2024-08, Vol.300, p.494-502</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c278t-65d38f4a02c2983db7cab08fd0f14b0784ae66f41b1407c973c4359b99df1bb63</cites><orcidid>0000-0003-2851-8330 ; 0009-0006-5144-0577</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38875948$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mirza, Muhammad Bilal</creatorcontrib><creatorcontrib>Gamboa, Adriana C.</creatorcontrib><creatorcontrib>Irlmeier, Rebecca</creatorcontrib><creatorcontrib>Hopkins, Benjamin</creatorcontrib><creatorcontrib>Regenbogen, Scott E.</creatorcontrib><creatorcontrib>Hrebinko, Katherine A.</creatorcontrib><creatorcontrib>Holder-Murray, Jennifer</creatorcontrib><creatorcontrib>Wiseman, Jason T.</creatorcontrib><creatorcontrib>Ejaz, Aslam</creatorcontrib><creatorcontrib>Wise, Paul E.</creatorcontrib><creatorcontrib>Ye, Fei</creatorcontrib><creatorcontrib>Idrees, Kamran</creatorcontrib><creatorcontrib>Hawkins, Alexander T.</creatorcontrib><creatorcontrib>Balch, Glen C.</creatorcontrib><creatorcontrib>Khan, Aimal</creatorcontrib><title>Association of Surgical Approaches and Outcomes in Total Mesorectal Excision and Margin Status for Rectal Cancer</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Despite being a key metric with a significant correlation with the outcomes of patients with rectal cancer, the optimal surgical approach for total mesorectal excision (TME) has not yet been identified. The aim of this study was to assess the association of the surgical approach on the quality of TME and surgical margins and to characterize the surgical and long-term oncologic outcomes in patients undergoing robotic, laparoscopic, and open TME for rectal cancer. Patients with primary, nonmetastatic rectal adenocarcinoma who underwent either lower anterior resection or abdominoperineal resection via robotic (Rob), laparoscopic (Lap), or open approaches were selected from the US Rectal Cancer Consortium database (2007-2017). Quasi-Poisson regression analysis with backward selection was used to investigate the relationship between the surgical approach and outcomes of interest. Among the 664 patients included in the study, the distribution of surgical approaches was as follows: 351 (52.9%) underwent TME via the open approach, 159 (23.9%) via the robotic approach, and 154 (23.2%) via the laparoscopic approach. There were no significant differences in baseline demographics among the three cohorts. The laparoscopic cohort had fewer patients with low rectal cancer (&lt;6 cm from the anal verge) than the robotic and open cohorts (Lap 28.6% versus Rob 59.1% versus Open 45.6%, P = 0.015). Patients who underwent Rob and Lap TME had lower intraoperative blood loss compared with the Open approach (Rob 200 mL [Q1, Q3: 100.0, 300.0] versus Lap 150 mL [Q1, Q3: 75.0, 250.0] versus Open 300 mL [Q1, Q3: 150.0, 600.0], P &lt; 0.001). There was no difference in the operative time (Rob 243 min [Q1, Q3: 203.8, 300.2] versus Lap 241 min [Q1, Q3: 186, 336] versus Open 226 min [Q1, Q3: 178, 315.8], P = 0.309) between the three approaches. Postoperative length of stay was shorter with robotic and laparoscopic approach compared to open approach (Rob 5.0 d [Q1, Q3: 4, 8.2] versus Lap 5 d [Q1, Q3: 4, 8] versus Open 7.0 d [Q1, Q3: 5, 9], P &lt; 0.001). There was no statistically significant difference in the quality of TME between the robotic, laparoscopic, and open approaches (79.2%, 64.9%, and 64.7%, respectively; P = 0.46). The margin positivity rate, a composite of circumferential margin and distal margin, was higher with the robotic and open approaches than with the laparoscopic approach (Rob 8.2% versus Open 6.6% versus Lap 1.9%, P = 0.17), Rob versus Lap (odds ratio 0.21; 95% confidence interval 0.05, 0.83) and Rob versus Open (odds ratio 0.5; 95% confidence interval 0.22, 1.12). There was no difference in long-term survival, including overall survival and recurrence-free survival, between patients who underwent robotic, laparoscopic, or open TME (Figure 1). In patients undergoing surgery with curative intent for rectal cancer, we did not observe a difference in the quality of TME between the robotic, laparoscopic, or open approaches. Robotic and open TME compared to laparoscopic TME were associated with higher margin positivity rates in our study. This was likely due to the higher percentage of low rectal cancers in the robotic and open cohorts. We also reported no significant differences in overall survival and recurrence-free survival between the aforementioned surgical techniques. •Optimal surgical approach for total mesorectal excision (TME) in rectal cancer remains unidentified.•Study reveals no significant differences in histopathological TME completeness, long-term outcomes (overall survival and recurrence-free survival), and overall TME quality between robotic and laparoscopic approaches in rectal cancer patients.•Higher margin positivity rates linked to robotic and open TME, potentially attributed to low rectal cancer cases in retrospective cohort.•Laparoscopic TME demonstrates lower intraoperative blood loss when compared to open surgical approach, robotic approach associated with fewer postoperative complications.•Robotic TME emerges as a safe and effective treatment option in rectal cancer surgery.•Large multicenter dataset analysis supports robust evidence-based practice in rectal cancer surgery.</description><subject>Laparoscopic surgery</subject><subject>Rectal cancer</subject><subject>Robotic surgery</subject><subject>Surgical margins</subject><subject>Survival outcomes</subject><subject>Total mesorectal excision</subject><issn>0022-4804</issn><issn>1095-8673</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kMFO4zAQhi20CLrAA3BBPu4lYRw7iSNOVVVYJBASLWfLcWxw1cbFk6x23x5HBY57mhnpm1_6P0IuGeQMWHW9yTeIeQGFyKHMgRdHZMagKTNZ1fwHmQEURSYkiFPyE3ED6W5qfkJOuZR12Qg5I_s5YjBeDz70NDi6GuOrN3pL5_t9DNq8WaS67-jTOJiwS4fv6ToMCXi0GKI107r8azxOARP5qFNCT1eDHkakLkT6fKAWujc2npNjp7doLz7nGXm5Xa4Xv7OHp7v7xfwhM0Uth6wqOy6d0FCYopG8a2ujW5CuA8dEC7UU2laVE6xlAmqTahnBy6Ztms6xtq34Gfl1yE013keLg9p5NHa71b0NIyoOVXJQ8qpMKDugJgbEaJ3aR7_T8Z9ioCbRaqOSaDWJVlCqJDr9XH3Gj-3Odt8fX2YTcHMAbCr5x9uo0HibDHR-sqa64P8T_wE2FI8Q</recordid><startdate>20240801</startdate><enddate>20240801</enddate><creator>Mirza, Muhammad Bilal</creator><creator>Gamboa, Adriana C.</creator><creator>Irlmeier, Rebecca</creator><creator>Hopkins, Benjamin</creator><creator>Regenbogen, Scott E.</creator><creator>Hrebinko, Katherine A.</creator><creator>Holder-Murray, Jennifer</creator><creator>Wiseman, Jason T.</creator><creator>Ejaz, Aslam</creator><creator>Wise, Paul E.</creator><creator>Ye, Fei</creator><creator>Idrees, Kamran</creator><creator>Hawkins, Alexander T.</creator><creator>Balch, Glen C.</creator><creator>Khan, Aimal</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2851-8330</orcidid><orcidid>https://orcid.org/0009-0006-5144-0577</orcidid></search><sort><creationdate>20240801</creationdate><title>Association of Surgical Approaches and Outcomes in Total Mesorectal Excision and Margin Status for Rectal Cancer</title><author>Mirza, Muhammad Bilal ; Gamboa, Adriana C. ; Irlmeier, Rebecca ; Hopkins, Benjamin ; Regenbogen, Scott E. ; Hrebinko, Katherine A. ; Holder-Murray, Jennifer ; Wiseman, Jason T. ; Ejaz, Aslam ; Wise, Paul E. ; Ye, Fei ; Idrees, Kamran ; Hawkins, Alexander T. ; Balch, Glen C. ; Khan, Aimal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c278t-65d38f4a02c2983db7cab08fd0f14b0784ae66f41b1407c973c4359b99df1bb63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Laparoscopic surgery</topic><topic>Rectal cancer</topic><topic>Robotic surgery</topic><topic>Surgical margins</topic><topic>Survival outcomes</topic><topic>Total mesorectal excision</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mirza, Muhammad Bilal</creatorcontrib><creatorcontrib>Gamboa, Adriana C.</creatorcontrib><creatorcontrib>Irlmeier, Rebecca</creatorcontrib><creatorcontrib>Hopkins, Benjamin</creatorcontrib><creatorcontrib>Regenbogen, Scott E.</creatorcontrib><creatorcontrib>Hrebinko, Katherine A.</creatorcontrib><creatorcontrib>Holder-Murray, Jennifer</creatorcontrib><creatorcontrib>Wiseman, Jason T.</creatorcontrib><creatorcontrib>Ejaz, Aslam</creatorcontrib><creatorcontrib>Wise, Paul E.</creatorcontrib><creatorcontrib>Ye, Fei</creatorcontrib><creatorcontrib>Idrees, Kamran</creatorcontrib><creatorcontrib>Hawkins, Alexander T.</creatorcontrib><creatorcontrib>Balch, Glen C.</creatorcontrib><creatorcontrib>Khan, Aimal</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mirza, Muhammad Bilal</au><au>Gamboa, Adriana C.</au><au>Irlmeier, Rebecca</au><au>Hopkins, Benjamin</au><au>Regenbogen, Scott E.</au><au>Hrebinko, Katherine A.</au><au>Holder-Murray, Jennifer</au><au>Wiseman, Jason T.</au><au>Ejaz, Aslam</au><au>Wise, Paul E.</au><au>Ye, Fei</au><au>Idrees, Kamran</au><au>Hawkins, Alexander T.</au><au>Balch, Glen C.</au><au>Khan, Aimal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Surgical Approaches and Outcomes in Total Mesorectal Excision and Margin Status for Rectal Cancer</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2024-08-01</date><risdate>2024</risdate><volume>300</volume><spage>494</spage><epage>502</epage><pages>494-502</pages><issn>0022-4804</issn><issn>1095-8673</issn><eissn>1095-8673</eissn><abstract>Despite being a key metric with a significant correlation with the outcomes of patients with rectal cancer, the optimal surgical approach for total mesorectal excision (TME) has not yet been identified. The aim of this study was to assess the association of the surgical approach on the quality of TME and surgical margins and to characterize the surgical and long-term oncologic outcomes in patients undergoing robotic, laparoscopic, and open TME for rectal cancer. Patients with primary, nonmetastatic rectal adenocarcinoma who underwent either lower anterior resection or abdominoperineal resection via robotic (Rob), laparoscopic (Lap), or open approaches were selected from the US Rectal Cancer Consortium database (2007-2017). Quasi-Poisson regression analysis with backward selection was used to investigate the relationship between the surgical approach and outcomes of interest. Among the 664 patients included in the study, the distribution of surgical approaches was as follows: 351 (52.9%) underwent TME via the open approach, 159 (23.9%) via the robotic approach, and 154 (23.2%) via the laparoscopic approach. There were no significant differences in baseline demographics among the three cohorts. The laparoscopic cohort had fewer patients with low rectal cancer (&lt;6 cm from the anal verge) than the robotic and open cohorts (Lap 28.6% versus Rob 59.1% versus Open 45.6%, P = 0.015). Patients who underwent Rob and Lap TME had lower intraoperative blood loss compared with the Open approach (Rob 200 mL [Q1, Q3: 100.0, 300.0] versus Lap 150 mL [Q1, Q3: 75.0, 250.0] versus Open 300 mL [Q1, Q3: 150.0, 600.0], P &lt; 0.001). There was no difference in the operative time (Rob 243 min [Q1, Q3: 203.8, 300.2] versus Lap 241 min [Q1, Q3: 186, 336] versus Open 226 min [Q1, Q3: 178, 315.8], P = 0.309) between the three approaches. Postoperative length of stay was shorter with robotic and laparoscopic approach compared to open approach (Rob 5.0 d [Q1, Q3: 4, 8.2] versus Lap 5 d [Q1, Q3: 4, 8] versus Open 7.0 d [Q1, Q3: 5, 9], P &lt; 0.001). There was no statistically significant difference in the quality of TME between the robotic, laparoscopic, and open approaches (79.2%, 64.9%, and 64.7%, respectively; P = 0.46). The margin positivity rate, a composite of circumferential margin and distal margin, was higher with the robotic and open approaches than with the laparoscopic approach (Rob 8.2% versus Open 6.6% versus Lap 1.9%, P = 0.17), Rob versus Lap (odds ratio 0.21; 95% confidence interval 0.05, 0.83) and Rob versus Open (odds ratio 0.5; 95% confidence interval 0.22, 1.12). There was no difference in long-term survival, including overall survival and recurrence-free survival, between patients who underwent robotic, laparoscopic, or open TME (Figure 1). In patients undergoing surgery with curative intent for rectal cancer, we did not observe a difference in the quality of TME between the robotic, laparoscopic, or open approaches. Robotic and open TME compared to laparoscopic TME were associated with higher margin positivity rates in our study. This was likely due to the higher percentage of low rectal cancers in the robotic and open cohorts. We also reported no significant differences in overall survival and recurrence-free survival between the aforementioned surgical techniques. •Optimal surgical approach for total mesorectal excision (TME) in rectal cancer remains unidentified.•Study reveals no significant differences in histopathological TME completeness, long-term outcomes (overall survival and recurrence-free survival), and overall TME quality between robotic and laparoscopic approaches in rectal cancer patients.•Higher margin positivity rates linked to robotic and open TME, potentially attributed to low rectal cancer cases in retrospective cohort.•Laparoscopic TME demonstrates lower intraoperative blood loss when compared to open surgical approach, robotic approach associated with fewer postoperative complications.•Robotic TME emerges as a safe and effective treatment option in rectal cancer surgery.•Large multicenter dataset analysis supports robust evidence-based practice in rectal cancer surgery.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38875948</pmid><doi>10.1016/j.jss.2024.05.032</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2851-8330</orcidid><orcidid>https://orcid.org/0009-0006-5144-0577</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0022-4804
ispartof The Journal of surgical research, 2024-08, Vol.300, p.494-502
issn 0022-4804
1095-8673
1095-8673
language eng
recordid cdi_proquest_miscellaneous_3068755365
source ScienceDirect Freedom Collection 2022-2024
subjects Laparoscopic surgery
Rectal cancer
Robotic surgery
Surgical margins
Survival outcomes
Total mesorectal excision
title Association of Surgical Approaches and Outcomes in Total Mesorectal Excision and Margin Status for Rectal Cancer
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T19%3A27%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20of%20Surgical%20Approaches%20and%20Outcomes%20in%20Total%20Mesorectal%20Excision%20and%20Margin%20Status%20for%20Rectal%20Cancer&rft.jtitle=The%20Journal%20of%20surgical%20research&rft.au=Mirza,%20Muhammad%20Bilal&rft.date=2024-08-01&rft.volume=300&rft.spage=494&rft.epage=502&rft.pages=494-502&rft.issn=0022-4804&rft.eissn=1095-8673&rft_id=info:doi/10.1016/j.jss.2024.05.032&rft_dat=%3Cproquest_cross%3E3068755365%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c278t-65d38f4a02c2983db7cab08fd0f14b0784ae66f41b1407c973c4359b99df1bb63%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=3068755365&rft_id=info:pmid/38875948&rfr_iscdi=true