title: 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.
abstract: BACKGROUND
  Robotic total mesorectal excision (R-TME), a novel way for minimally invasive treatment of rectal cancer, was shown in previous studies to be safe and effective. However, comparison with laparoscopic total mesorectal excision (L-TME) has drawn contradictory disputes, especially concerning operative high-risk patients. The aim of this study was to compare R-TME and L-TME on the rectal technical approach.
  
  
  METHODS
  Between October 2009 and March 2013, a total of 120 consecutive rectal carcinomas, operated for sphincter-saving procedure, were enrolled. The patient population included the last 60 laparoscopic procedures and the first 60 robotic surgeries (six hybrid approaches, then 54 full robotic surgeries). There were no exclusions.
  
  
  RESULTS
  Patients' baseline characteristics were similar in both the R-TME and L-TME groups. Outcomes were equivalent for blood loss (200 vs. 100 mL), postoperative hospital stay (12 vs. 11 days), conversion rate (3.2 vs. 4.8 %), lymph nodes yield (15 vs. 19), no positive distal margin (0 %), positive radial margin (6.4 vs. 9.3 %), diverting ileostomy (73 vs. 58 %) and severe morbidity (28 vs. 20 %). Significant differences were found for median operative time (274 vs. 228 min; p = 0.003) and proctectomy performed via transanal approach (1.7 vs. 16.7 %; p = 0.004). The R-TME operative time curve stabilized to 245 min after the first 25 procedures.
  
  
  CONCLUSIONS
  For rectal cancer, R-TME may be as feasible and safe as L-TME in terms of technique. In our practice and for difficult cases, R-TME allows complete rectal dissection by an abdominal approach, while L-TME requires a transanal approach.
authors.affiliation: Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Colombo
authors.affiliation: Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Bertrand
authors.affiliation: Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
authors.forename: Mathias
authors.initials: M
authors.lastname: Alline
authors.affiliation: Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Boulay
authors.affiliation: Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Mourregot
authors.affiliation: Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Carrère
authors.affiliation: Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
authors.forename: François
authors.initials: F
authors.lastname: Quénet
authors.affiliation: Biometrics Unit, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France.
authors.forename: Marta
authors.initials: M
authors.lastname: Jarlier
authors.affiliation: Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d'Aurelle, Montpellier, France. Philippe.Rouanet@icm.unicancer.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rouanet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D015996:Survival Rate