Influence of Minimally Invasive Resection Technique on Sphincter Preservation and Short-term Outcome in Low Rectal Cancer in the Netherlands.

Background Transanal and robotic-assisted total mesorectal excision are techniques that can potentially overcome challenges encountered with a pure laparoscopic approach in patients with rectal cancer. Objective The aim of this study was to evaluate the proportion and predictive factors of restorative procedures and subsequent short-term outcomes of three minimally invasive techniques to treat low rectal cancer. Design This is a nationwide observational comparative registry study. Settings Rectal cancer patients selected from the mandatory Dutch ColoRectal Audit. Patients Patients with low rectal cancer (≤5 centimeter) that underwent curative minimally invasive total mesorectal excision between 2015 and 2018. Main outcome measures Proportion of restorative procedure, positive circumferential resection margin, and postoperative complications. Results A total of 3,466 patients were included for analysis, of which 33% underwent a restorative procedure. Resections were performed laparoscopic in 2,845 patients, transanal in 448 patients and robot-assisted in 173 patients, with a proportion of restorative procedures of 28%, 66% and 40%, respectively. The Trans-anal approach was independently associated with a restorative procedure (OR 4.11; 95% CI 3.21-5.26; p 75, American Society of Anesthesiologist ≥3, body mass index >30, history of abdominal surgery, clinical T4-stage, mesorectal fascia ≤1 millimeter, neoadjuvant therapy and having a procedure in 2015-2016 versus 2017-2018. The circumferential resection margin involvement was similar for all three groups (5.4%, 5.1% and 5.1%). Short-term postoperative complications were less favorable for the newer techniques compared to the Laparoscopic approach. Limitations This study was limited because of the registry's variables and different group sizes. Conclusion Patients with low rectal cancer in the Netherlands are more likely to get a restorative procedure with a transanal approach, compared to a laparoscopic or robotic procedure. Short term oncological outcomes are comparable between the three minimally invasive techniques. See Video Abstract at http://links.lww.com/DCR/B608 .