Robotic-assisted laparoscopic low anterior resection versus trans-anal total mesorectal excision for malignant rectal lesion: a prospective cohort trial

Abstract

Introduction Colorectal carcinoma is one of the most common malignancies of the gastrointestinal tract. The aim of the present study was to compare the trans-anal total mesorectal excision (TaTME) to the robotic-assisted laparoscopic resection of mid- and low rectal carcinoma regarding the clinical and oncological outcome. Methods This was a prospective cohort study. This study was held on patients presenting with rectal cancer. Eighty patients were included divided into two groups, 40 patients were subjected to TaTME and 40 patients were subjected to robotic-assisted resection. Results Rectal resection was performed in both groups and the results were compared; total time was significantly less in TaTME group (mean time was 179.10 min in TaTME and 266.35 in robotic, P value < 0.001), estimated blood loss was significantly less in TaTME group (mean was 130.50 ml in TaTME and 212 ml in robotic, P value=0.017), cost was significantly less in TaTME group (mean cost ×1000L.E was 46.15 in TaTME and 110.70 in robotic, P value less than 0.001), distal margin was significantly more in the robotic group (mean was 2.68 compared with 2.02 in TaTME, P value = 0.002), hospital stay was significantly less in the robotic group (mean of 4.6 days compared with 5.1 for TaTME, P value = 0.014) and there was no statistically significant difference concerning the total number of lymph nodes, proximal and circumferential margins. Conclusion This study suggests that robotic surgery is safe and effective and has some advantages concerning distal margins of low rectal resections. Also, TaTME can be compared with robotic surgery and represents an effective and less expensive alternative for robotic surgery.