Robotic versus transanal total mesorectal excision in sexual, anorectal, and urinary function: a multicenter, prospective, observational study

Abstract

Purpose Improved long-term survival after low anterior resection (LAR) for rectal cancer highlights the importance of functional outcome. Urogenital and anorectal dysfunction is frequently reported after conventional LAR. Advanced minimally invasive techniques such as robotic (RoTME) and transanal total mesorectal excision (TaTME) might improve functional results by precisely dissecting and preserving autonomic nerves. We compared functional outcomes after RoTME or TaTME in a multicenter study. Methods One hundred twenty patients (55 RoTME/65 TaTME) were prospectively included in four participating centers. Anorectal (Wexner and low anterior resection syndrome (LARS) Score), urinary (International Consultation on Incontinence—Male/Female Lower Urinary Tract Symptoms Score (ICIQ-MLUTS/ICIQ-FLUTS) and International Prostate Symptom Scale (IPSS)), and sexual (International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI)) outcomes at 12 months after surgery were compared to preoperative scores. The response rate to the 1-year postoperative functional assessment by questionnaire was 79.5%. Results RoTME enabled better anorectal function compared to TaTME (LARS score 4.3 ± 2.2 vs. 9.8 ± 1.5, p = 0.038, respectively). TaTME proved superior at preserving male urinary function, while female urinary function was comparable in both groups, with only mild postoperative impairment (RoTME vs. TaTME, respectively: ICIQ-MLUTS 13.8 ± 4.9 vs. 1.8 ± 5.8, p = 0.038; ICIQ-FLUTS Incontinence Score − 0.3 ± 1.0 vs. − 0.2 ± 0.9, p = 0.844). Both techniques demonstrated comparable male (RoTME − 13.4 ± 2.7 vs. TaTME − 11.7 ± 3.4, p = 0.615) and female (RoTME 5.2 ± 4.6 vs. TaTME 10.5 ± 6.4, p = 0.254) sexual function. Conclusion After adjustment for risk factors, RoTME provided better anorectal functional results, whereas TaTME was better at preserving male urinary function. Overall, both techniques demonstrated only mild postoperative functional impairment.

Transanal total mesorectal excision for rectal cancer: it’s come a long way and here to stay

“…Since then, there has been a lot more data on both short-and moderate-term oncological outcomes which suggests that TaTME is as safe as laparoscopic TME and other approaches [26][27][28] (Table 1 [21,26,[29][30][31]). Roodbeen et al [32] for instance reported a local recurrence rate of only 3% in their 2021 multicenter observational study of 767 patients.…”

“…A multicenter prospective observational study comparing 55 robotic TME and 65 TaTME also reported similar sexual functions in both groups. The robotic group however reported slightly better anorectal function with the TaTME group superior in terms of preserving male urinary function [ 29 ]. The dearth of high-level evidence and limited studies makes it challenging to comment on the functional results of TaTME and we have to await further high-quality evidence such as the ongoing COLOR-III trial to shed more light on this issue [ 35 ].…”

Anorectal functional outcomes after transanal total mesorectal excision (TaTME): a Random Forest analysis to predict patients' outcomes

“…A multicenter observational study [29] reported that the robotic approach could be superior in preserving post-operative anorectal function comparing TaTME, even though this result may be in uenced by the consistent difference in the proportion of patients who underwent NAD among the groups used for comparison of data.…”

Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries

“…Several retrospective studies have attempted to demonstrate the efficacies of taTME compared to laparoscopic and/or robotic TME, but convincing results have not yet been obtained (Table 1). 44,[47][48][49][50][51] Even international expert consensus has had difficulty reaching agreement on the indications for or best practice of taTME. 29 Most of the favorable results of taTME have been reported from large referral centers with highly skilled colorectal surgeons.…”