SP5.5 Peri-operative, Oncological and Functional Outcomes of Robotic versus Transanal Total Mesorectal Excision in patients with Rectal Cancer: A Systematic Review and Meta-analysis

Abstract Background To evaluate comparative outcomes of robotic low anterior resection (RTME) and spinal Trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer. Methods A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing RTME versus TaTME for low rectal cancer were included. Primary outcomes were post-operative complications namely, anastomosis leak, SSI, overall complications rate, and Clavien-Dindo complications rate. Operative time, conversion to open, Intra-operative blood loss, ITU and hospital length of stay (LOS), post-operative complications, oncological outcomes, and functional outcomes were the evaluated outcome parameters. Results Twelve studies with a total number of 3025 patients divided between the Robotic group (n=1881) and TaTME group (n=1144) were included. There was a significant difference between the two groups regarding Operative time (P=0.39), conversion to open (P=0.29) and intra-operative blood loss (P= 0.62). Clavien-Dindo ≥ 3 complications rate (P=0.25), anastomosis leak (P= 0.89), re-operation (P=0.62), re-admission rate (P=0.92), R0 resection (P= 0.52), ITU LOS (P= 0.63) and total LOS (P=0.30) showed similar results between the two groups. RTME group showed a higher rate of harvested lymph nodes (P= 0.04) and completed TME (P=0.05). Wexner and LARS scores showed significantly better functional results in the RTME group compared to the TaTME group (P= 0.0009) and (P= 0.00001), respectively. Conclusion Compared to TaTME, RTME provides significantly better functional outcomes, a higher number of harvested lymph and complete TME with a similar postoperative complications rate.