AB017. SOH21AS078. Surgical approach for rectal cancer: a network meta-analysis comparing open, laparoscopic, robotic and transanal total mesorectal excision (TME) approaches
Colorectal Session

AB017. SOH21AS078. Surgical approach for rectal cancer: a network meta-analysis comparing open, laparoscopic, robotic and transanal total mesorectal excision (TME) approaches

Odhrán Kevin Ryan, Eanna Ryan, Ben Creavin, Michael Kelly, Emanuele Rausa, Fausto Petrelli, Gianluca Bonitta, Rory Kennelly, Ann Hanly, Seán Martin, Des Winter

Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland

Background: The optimal approach for total mesorectal excision (TME) of rectal cancer remains controversial. Aim: To compare short- and long-term outcomes after open (OpTME), laparoscopic (LapTME), robotic (RoTME) and transanal TME (TaTME).

Methods: A systematic search of electronic databases was performed up to January 1 2020 for randomized controlled trials (RCTs) comparing at least 2 TME strategies. A Bayesian arm-based random effect network meta-analysis (NMA) was performed, specifically, a mixed treatment comparison (MTC).

Results: Thirty RCTs (and six updates) of 5,586 patients with rectal cancer were included. No significant differences were identified in recurrence rates or survival rates. Operating time was shorter with OpTME [surface under the cumulative ranking curve (SUCRA) 0.96] compared to LapTME, RoTME and TaTME. Although OpTME was associated with the most blood loss (SUCRA 0.90) and had a slower recovery with increased length of stay (SUCRA 0.90) compared to the minimally invasive techniques, there was no difference in postoperative morbidity. OpTME was associated with a more complete TME specimen compared to LapTME [risk ratio (RR) 1.05, 95% credible interval (CrI) 1.01, 1.11], and TaTME had less involved circumferential resection margins (CRMs) (RR 0.173, 95% CrI 0.02, 0.76) versus LapTME. There were no differences between the modalities in terms of deep TME defects, DRM distance, or lymph node yield.

Conclusions: While OpTME was the most effective TME modality for short term histopathological resection quality, there was no difference in long-term oncologic outcomes. Minimally invasive approaches enhance postoperative recovery, at the cost of longer operating times. Technique selection should be based on individual tumour characteristics and patient expectations, as well as surgeon and institutional expertise.

Keywords: Rectal cancer; surgical techniques; surgical outcomes; survival

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-21-ab017
Cite this abstract as: Ryan OK, Ryan E, Creavin B, Kelly M, Rausa E, Petrelli F, Bonitta G, Kennelly R, Hanly A, Martin S, Winter D. SOH21AS078. Surgical approach for rectal cancer: a network meta-analysis comparing open, laparoscopic, robotic and transanal total mesorectal excision (TME) approaches. Mesentery Peritoneum 2021;5:AB017.

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