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Completeness of total mesorectum excision of laparoscopic versus robotic surgery: a review with a meta-analysis

  • Milone, Marco1
  • Manigrasso, Michele1
  • Velotti, Nunzio1
  • Torino, Stefania2
  • Vozza, Antonietta2
  • Sarnelli, Giovanni1
  • Aprea, Giovanni1
  • Maione, Francesco1
  • Gennarelli, Nicola1
  • Musella, Mario1
  • De Palma, Giovanni Domenico1
  • 1 Federico II University of Naples, Department of Clinical Medicine and Surgery, Via Sergio Pansini, 5, Naples, 80131, Italy , Naples (Italy)
  • 2 Federico II University of Naples, Department of Pharmacy, Via Sergio Pansini, 5, Naples, 80131, Italy , Naples (Italy)
Published Article
International Journal of Colorectal Disease
Publication Date
May 06, 2019
DOI: 10.1007/s00384-019-03307-0
Springer Nature


BackgroundTME has revolutionized the surgical management of rectal cancer, and since the introduction of robotic TME (RTME), many reports have shown the feasibility and the safety of this approach. However, concerns persist regarding the advantages of robotic in surgery for the completeness of TME. The aim of this review is to compare robotic versus laparoscopic total mesorectal excision (TME) in rectal cancer, focusing on the completeness of TME.MethodsA systematic search was performed in the electronic databases for all available studies comparing RTME versus conventional laparoscopic LTME with declared grade of mesorectum excision. Data regarding sample size, clinical and demographic characteristics, number of complete, nearly complete, and incomplete TME were extracted. Primary outcome was the number of complete TME in robotic and laparoscopic procedures. Secondary outcomes were the numbers of nearly complete and incomplete TME in robotic and laparoscopic rectal resections.ResultsTwelve articles were included in the final analysis. Complete TME was reported by all authors, involving 1510 procedures, showing a significant difference in favor of robotic surgery (OR = 1.83, 95% CI 1.08–3.10, p = 0.03). Nearly complete and incomplete TME showed no significant difference between the procedures. Meta-regression analysis showed that none of patients’ and tumors’ characteristics significantly impacted on complete TME.ConclusionsOur results underline that the robotic approach to rectal resection is the better way to obtain a complete TME. However, it is mandatory that randomized clinical trials should be performed to assess definitively if robotic minimally invasive surgery is better than a laparoscopic resection.

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