Comparison of short- and long-term outcomes among laparoscopic, robotic-assisted, and transanal total mesorectal excision procedures in patients with rectal cancer: a propensity score-matching analysis.

G-Y Chen, C-K Liao, J-F You, C-C Lai, S-H Huang

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Article in Techniques in coloproctology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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G-Y ChenDepartment of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.ORCID 0009-0009-2614-4751

C-K LiaoDivision of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.ORCID 0000-0002-7497-4444

J-F YouDivision of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.ORCID 0000-0001-5748-1659

C-C LaiDivision of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.ORCID 0000-0003-4819-2104

S-H HuangDivision of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan. shhuang55@gmail.com.ORCID 0000-0003-2673-9850

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6 · The paper itself

Abstract

backgroundTotal mesorectal excision (TME) remains the oncologic standard for rectal cancer surgery; however, technical challenges persist in the minimally invasive treatment of low rectal cancer. Transanal TME (TaTME) and robotic TME were developed to overcome the limitations of laparoscopic TME in confined pelvic spaces. Despite promising results, comparative evidence among these approaches remains limited and heterogeneous. To address this gap, we conducted a propensity score-matched analysis to evaluate and compare the clinical and oncologic outcomes of TaTME, robotic TME, and laparoscopic TME in patients with rectal cancer treated at a high-volume tertiary center.

methodsThis retrospective study included patients with rectal cancer who underwent restorative proctectomy between 2015 and 2021. Propensity score matching was used to balance demographic, clinical, and treatment variables across the three groups. Outcomes were analyzed using standard statistical methods.

resultsAfter matching, 240 patients were included (40 TaTME, 40 robotic TME, and 160 laparoscopic TME). TaTME and robotic TME demonstrated significantly lower overall complication rates than laparoscopic TME (27.5% versus 20.0% versus 39.4%, p = 0.033). The circumferential resection margin positivity rate was highest in the laparoscopic group (10.6% versus 0% versus 2.5%, p = 0.031). However, 5-year overall survival (82.5% versus 85.0% versus 88.1%, p = 0.251), disease-free survival (75.0% versus 72.5% versus 73.8%, p = 0.772), local recurrence (17.5% versus 12.5% versus 24.7%, p = 0.488), and distal metastasis (17.5% versus 22.5% versus 25.2%, p = 0.694) did not significantly differ among groups.

conclusionsAll three minimally invasive TME techniques achieved comparable long-term oncologic outcomes. Surgical approach should be tailored on the basis of surgeon expertise and patient-specific factors.

Indexed as

LaparoscopyProctectomyRectal NeoplasmsRobotic Surgical ProceduresTransanal Endoscopic SurgeryAdultAgedFemaleHumansMaleMargins of ExcisionMiddle AgedPostoperative ComplicationsPropensity ScoreRectumRetrospective StudiesLaparoscopyRectal cancerRoboticsSurgeryTotal mesorectal excisionTransanal total mesorectal excision

Identifiers

PMID40824598

DOI10.1007/s10151-025-03204-5

PMCPMC12361301

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