BACKGROUND Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation. METHODS This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months. RESULTS Upon multivariate analysis, histologic grade (P = 0.016), and stage (P < 0.001) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P < 0.05). Multivariable analyses observed the surgical method (P = 0.037), histologic grade (P = 0.006), and CRM involvement (P = 0.043) were the independent factors of DFS, whereas histologic grade (P = 0.011) and pathologic stage (P = 0.022) were the independent prognostic variables of OS. CONCLUSIONS This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.

中文翻译：

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直肠癌全直肠系膜切除术中各种手术方法的病理肿瘤学结果的观察性研究：单中心分析。

背景技术全直肠系膜切除术（TME）伴或不伴新辅助同时放化疗（CCRT）是直肠癌（RC）的治疗方法。近来，使用常规腹腔镜手术（LS）或机器人辅助手术（RS）的病例一直在稳定增长。然而，来自不同手术方法的各种肿瘤学结果仍在研究中。方法这是一项回顾性观察性研究，包括300名连续的RC患者，他们在单一真实数据中心接受了各种TME技术（RS，n = 88； LS，n = 37；开放手术，n = 175），以比较病理学和肿瘤学结果，平均随访48个月。结果经多因素分析，组织学分级（P = 0.016）和分期（P <0。001）是介入环周切缘（CRM）的独立因素。Kaplan-Meier生存分析确定RS，早期病理阶段，负CRM参与和病理完全缓解与更好的总生存期（OS）和无病生存期（DFS）显着相关（所有P <0.05）。多变量分析观察到手术方法（P = 0.037），组织学等级（P = 0.006）和CRM受累（P = 0.043）是DFS的独立因素，而组织学等级（P = 0.011）和病理分期（P = 0.022） ）是OS的独立预后变量。结论本研究确定RS TME是可行的，因为与其他方法相比，它具有更少的CRM参与和更好的肿瘤学结果。影响CRM和预后的重要因素取决于组织学分级，肿瘤深度和术前CCRT。由于接受TME的RC患者的肿瘤学结局良好，因此RS可能是可接受的选择。