EP588 - Trans-Anal Total Mesorectal Excision versus Robotic Total Mesorectal Excision for Rectal Adenocarcinoma Surgical Management

Sunday, May 11, 2025

4:33 PM – 4:38 PM PT

Location: Monitor 6, Sails Pavilion, Upper Level

ePoster Presenter(s)

SW

Sonia Wu, MD

Resident
University of Montreal
Montreal, Quebec, Canada

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

FD

François Dagbert, MD

Colorectal Surgeon
Centre Hospitalier de l'Universite de Montreal
Montreal, Quebec, Canada

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

SL

Séverine Lemieux, N/A

Medical Student
Faculty of Medicine of Université de Montréal
La Prairie, Quebec, Canada

Disclosure information not submitted.
HS

Herawaty Sebajang, Dr

Colorectal surgeon
CHUM
Montréal, Quebec, Canada

Disclosure information not submitted.
FS

Franck Schwenter, n/a

Professor
Montréal University Hospital
Montreal, Quebec, Canada

Disclosure information not submitted.
CR

Carole S. Richard, MD,FRCS(C)

Associate professor
Universite de Montreal
Montreal, Quebec, Canada

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
RR

Richard Ratelle, MD FRCSC

Chief of digetive surgery unit
University of Montreal
Montreal, Quebec, Canada

Disclosure information not submitted.
MG

Marianne Gagnon-Konamna, MD, FRCSC, FACS, FASCRS

Attending staff
University of Montreal
Montreal, Quebec, Canada

Disclosure information not submitted.
LR

Loungnarath Rasmy, n/a

Colorectal surgeon
Université de Montréal
Montreal, Quebec, Canada

Disclosure information not submitted.
HA

Hefzi Alratrout, MBBS, DES, DESC

Assistant consultant and consultant
Imam Abdulrahman Bin Faisal University
Dhahran, Ash Sharqiyah, Saudi Arabia

Disclosure information not submitted.
ED

Eric De Broux, MD, MSc,FRCSC

Colorectal surgeon and teaching professor at the Montréal University Hospital (CHUM)
University of Montreal
Mont-Royal, Quebec, Canada

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Sonia Wu, MD: This individual has no financial relationships with ineligible companies.

François Dagbert, MD: This individual has no financial relationships with ineligible companies.

Carole S. Richard, MD,FRCS(C): This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: The surgical approach to rectal adenocarcinoma has evolved greatly in recent years. With the standardization of Total Mesorectal Excision (TME) and the development of increasingly advanced equipment, many tools are now available to colorectal surgeons. Direct comparison of Trans-anal Total Mesorectal Excision (TaTME) and Robotic Total Mesorectal Excision (R-TME) remains scarce in literature.
The aim of this study is to compare TaTME with R-TME with respect to post-operative complications, TME quality and oncologic outcomes. The secondary outcome was the comparison of tumour, operative and patient characteristics.

Methods/Interventions: This study is a single-center retrospective cohort study based on a prospectively collected database. All consecutive patients who underwent sphincter-sparing proctectomy with TaTME or R-TME for a mid-low rectal adenocarcinoma between January 2017 and November 2022 at the Centre Hospitalier de l’Université de Montréal (CHUM) were included. All surgeons are trained colorectal surgeons. Decision between TaTME or R-TME was based on surgeon experience, clinical judgment and resource availability. Statistical analysis was done with SPSS, using descriptive analysis and mean comparison with Chi-Square or T-tests. Overall survival was estimated with Kaplan-Meier curves, along with log-rank tests.

Results/Outcomes: 43 cases of TaTME and 74 of R-TME totalling 117 cases were included in the study. Mean age was 63 years old in both groups. Mean BMI was approximately 28-28.5 in both categories. Early post-operative complications Clavien-Dindo Grade 3+ ( < 30 days) occurred in 19% of TaTME cases, compared to 10% of R-TME cases (p = 0.154). Fourteen percent of patients had an anastomotic leak following TaTME, while 12% did in the R-TME group (p = 0.780). In the TaTME group, 28% developed anastomotic stenosis, compared to 11% in the R-TME group (p = 0.018). Mean estimated blood loss (EBL) was 271 ml in the TaTME group, compared with 168 in the R-TME group (p = 0.006). Mean operative time was 367 minutes in the TaTME group, while 315 minutes in the R-TME group (p < 0.001). Thirty percent of TaTME cases were performed with a two-team approach, versus only 2% of R-TME cases (p < 0.001)
TME was complete in 88% of TaTME cases, compared with 95% in R-TME cases (p = 0.288). Local recurrence occurred in 9% of TaTME cases, versus 2.7% of R-TME cases (p = 0.119). Overall survival was 83.2 months following TaTME, compared to 80.9 months following R-TME (p = 0.652).

This single center study is limited by its retrospective nature. Another limitation is the referral center status of our hospital, with many patients continuing oncologic follow-up in regional centers, affecting our ability to follow oncologic events.

Conclusion/Discussion: Our study aimed to elucidate whether the trans-anal approach and the robotic approach could be considered two equivalent tools in the surgical management of rectal adenocarcinoma. We did not find any significant differences in oncologic outcomes, including overall survival, local recurrence rate or distant metastasis rate. TME completeness was comparable in both groups. Our data seems to show that while TaTME and R-TME may be oncologically equivalent, TaTME is associated with higher blood loss, operative time and anastomotic stenosis. A cost analysis would be an interesting next step to our study.