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Copyright ©The Author(s) 2020.
World J Gastroenterol. Aug 14, 2020; 26(30): 4394-4414
Published online Aug 14, 2020. doi: 10.3748/wjg.v26.i30.4394
Table 1 Goals of care in rectal cancer patients
GoalsParameters
OncologicalOverall survival, disease-free survival, local recurrence rate, cure
OstomyAvoidance of permanent ostomy, stoma-free survival
AnatomicalOrgan preservation
Sphincter preservation
FunctionalPreservation of QoL
Anorectal and defacatory function
Sexual and urinary function
Peri-/postoperative morbidityLow intraoperative complication rate
Avoidance of collateral injuries
Low postoperative complication rates (leak, SSI, and any Clavien-Dindo complication > 2)
Table 2 Surgical platforms for rectal neoplasias
Oncological resectionEndoluminal local excision
Sphincter preserving/restorative surgeryOpen TMEColonoscopic EMR/ESD
Laparoscopic TMETransanal excision
Robotic TMETransanal endoscopic microsurgery
Transanal TMETransanal minimally invasive surgery (L-TAMIS)
Robotic TAMIS
Nonrestorative surgeryOpen APR
Laparoscopic APR
Robotic APR
Transanal APR
Table 3 Major randomized controlled trials in minimally invasive surgery for rectal cancer
TrialYearComparisonEnrollmentPrimary end pointFindings
MRC CLASICC[6]2005Lap vs Open253 vs 128Clear margins/mortalityColon and rectal surgery compared, 12% vs 6% positive CRM
MRC CLASICC FU[81]2013No differences seen OS, DFS, LR at 62 mo
COREAN[7]2010Lap vs Open170 vs 170No differences seen in multiple short-term outcomes
COREAN FU[82]20143-yr disease free survivalNoninferiority of laparoscopic approach was met, 79% vs 72% DFS
COLOR II[32]2013Lap vs Open699 vs 345Similar safety and margins, laparoscopic surgery had quicker recovery
COLOR II FU[8]20153-yr locoregional recurrenceSimilar recurrence rates at 5% for each group
ACOSOG Z6051[9]2015Lap vs Open240 vs 222Clear marginsNoninferiority study not able to reach boundary of 6%
ACOSOG Z6051 FU[11]2019No differences seen in long term oncologic outcomes
ALaCaRT[10]2015Lap vs Open238 vs 237Clear marginsNoninferiority study not able to reach boundary of 8%
ALaCaRT FU[12]2019No differences seen in long term oncologic outcomes
ROLARR[15]2017Lap vs Robot234 vs 237Conversion to open surgeryNo differences seen in conversion rate, 12% vs 8%
Kim et al[16]2018Lap vs Robot73 vs 66Completeness of TMESimilar TME specimens, 78% vs 80%
Bordeaux[17]2014Lap vs TaTME50 vs 50Quality of oncologic surgerySignificant decrease in CRM positivity for TaTME, 4% vs 18%
Bordeaux FU[54]2018No differences seen in long term oncologic outcomes at 60 months
Table 4 Selected laparoscopic vs open rectal cancer surgery studies
Ref.YrTrialSurgerynOR Time (min)EBL (mL)CVR (%)LOS (d)Comp (%)Mort (%)DRM+ (%)CRM+ (%)LNC-TME (%)DFS (%)OS (%)LRR (%)
Guillou et al[6]2005MC RCTLap2531159412
Open128135056
Lujan et al[83]2009SC RCTLap10119312717833041385724.8
Open1031722341033031181755.4
Kang et al[7]2010MC RCTLap170244200182141775
Open17019721792331872
Liang et al[43]2011SC RCTLap16913820776
Open17411819783
Lujan et al[84]2013MC PRLap138721783811101482
Open3018186114541161475
Van Der Pas et al[32]2013MC RCTLap739240200178401101388
Open3641884009372101492
Jeong et al[82]2014MC RCTLap17072882.6
Open17079854.9
Bonjer et al[8]2015MC RCTLap69975875
Open34571845
Stevenson et al[10]2015MC RCTLap23821010098191787
Open2351901508251392
Stevenson et al[12]2019MC RCTLap22580945.4
Open22582933.1
Fleshman et al[9]2015MC RCTLap2402662561175712121892
Open2222203187581281795
Fleshman et al[11]2019MC RCTLap24080854.6
Open22283864.5
Table 5 Selected laparoscopic vs robotic rectal cancer surgery studies
Ref.YrTrialSurgerynOR time (min)EBL (mL)CVR (%)LOS (d)Comp (%)Mort (%)DRM+ (%)CRM+ (%)LNC-TME (%)DFS (%)OS (%)LRR (%)
Patriti et al[36]2009SC RRLap37208127201032011
Robot2920213701226010
Cho et al[85]2015SC PSMLap2782721471102314.71679933.9
Robot27836117911025051581925.9
Jayne et al[15]2017MC RCTLap2342611283116.32475
Robot237298883315.12375
Wang et al[59]2017SC RCTLap6620716
Robot7124616
Kim et al[53]2017SC PSMLap2242491142414.9216878
Robot2242850133214207290
Law et al[49]2017SC PRLap171225100462218.21280745
Robot200260100161914.11482715
Rouanet et al[37]2018SC RRLap20023210010112411199088
Robot200243200210258158584
Sammour et al[44]2018SC ORobot27610024342.5227682872.4
Chang et al[86]2019SC ORobot114516673661611.317902.3
Table 6 Selected transanal total mesorectal excision rectal cancer surgery studies
Ref.YrTrialSurgerynOR time (min)EBL (mL)CVR (%)LOS (d)Comp (%)Mort (%)DRM+ (%)CRM+ (%)LNC-TME (%)DFS (%)OS (%)LRR (%)
Denost et al[17]2014SC RCTLap502641084422181762
TaTME5024047320841770
Lacy et al[31]2015SC OTaTME1400346159791972.3
Chen et al[51]2016MC PMRLap1001788857171017
TaTME50182682720417
Marks et al[55]2017SC OTaTME373907.4
Penna et al[87]2017MC OTaTME72027798322021785
Denost et al[54]2017SC RCTLap5071744.8
TaTME5073872.6
Persiani et al[42]2018SC PSMLap4627220721084
TaTME462760723087
Perdawood et al[33]2018SC PSMLap10033423911141132268
TaTME1002858208072258
Open100325704151101868
Perez et al[88]2017SC RRRobot60276108371588
TaTME5529137221590
Detering et al[18]2019MC PSMLap396963614
TaTME396274204
Law et al[34]2019SC PSMRobot402701505617113
TaTME40254905612013
Lee et al[19]2019MC PMRRobot4531894350161695
TaTME2771893330261692
Hol et al[56]2019SC OTaTME15952018781773.8
Wasmuth et al[20]2019MC OTaTME15711.6