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Completeness of total mesorectum excision of laparoscopic versus robotic surgery: a review with a meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

TME has revolutionized the surgical management of rectal cancer, and since the introduction of robotic TME (RTME), many reports have shown the feasibility and the safety of this approach. However, concerns persist regarding the advantages of robotic in surgery for the completeness of TME. The aim of this review is to compare robotic versus laparoscopic total mesorectal excision (TME) in rectal cancer, focusing on the completeness of TME.

Methods

A systematic search was performed in the electronic databases for all available studies comparing RTME versus conventional laparoscopic LTME with declared grade of mesorectum excision. Data regarding sample size, clinical and demographic characteristics, number of complete, nearly complete, and incomplete TME were extracted. Primary outcome was the number of complete TME in robotic and laparoscopic procedures. Secondary outcomes were the numbers of nearly complete and incomplete TME in robotic and laparoscopic rectal resections.

Results

Twelve articles were included in the final analysis. Complete TME was reported by all authors, involving 1510 procedures, showing a significant difference in favor of robotic surgery (OR = 1.83, 95% CI 1.08–3.10, p = 0.03). Nearly complete and incomplete TME showed no significant difference between the procedures. Meta-regression analysis showed that none of patients’ and tumors’ characteristics significantly impacted on complete TME.

Conclusions

Our results underline that the robotic approach to rectal resection is the better way to obtain a complete TME. However, it is mandatory that randomized clinical trials should be performed to assess definitively if robotic minimally invasive surgery is better than a laparoscopic resection.

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Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy

    Marco Milone, Michele Manigrasso, Nunzio Velotti, Giovanni Sarnelli, Giovanni Aprea, Francesco Maione, Nicola Gennarelli, Mario Musella & Giovanni Domenico De Palma

  2. Department of Pharmacy, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy

    Stefania Torino & Antonietta Vozza

Authors
  1. Marco Milone
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  2. Michele Manigrasso
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  3. Nunzio Velotti
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  4. Stefania Torino
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Correspondence to Marco Milone.

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Electronic supplementary material

Fig. 5a

Quality assessment of the included studies: a Cochrane Collaboration tool for assessing risk of bias (JPG 241 kb)

Fig. 5b

Newcastle-Ottawa Scale (NOS) quality assessment of nRCTs (JPG 244 kb)

Fig. 6

Publication bias of primary outcomes (PNG 380 kb)

Fig. 7

Publication bias of secondary outcomes (PNG 700 kb)

Fig. 8

Publication bias of combined analysis (PNG 696 kb)

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Milone, M., Manigrasso, M., Velotti, N. et al. Completeness of total mesorectum excision of laparoscopic versus robotic surgery: a review with a meta-analysis. Int J Colorectal Dis 34, 983–991 (2019). https://doi.org/10.1007/s00384-019-03307-0

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