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中国结直肠癌手术病例登记数据库2025年度报告：一项全国性前瞻性登记研究
李杨, 李心翔, 崔龙, 张卫, 池畔, 王自强, 石晋瑶, 揭志刚, 孙跃明, 卢云, 韩方海, 何显力, 陶凯雄, 王权, 王贵英, 王振宁, 李海, 钱群, 李乐平, 卫洪波, 李伟华, 房学东, 姚宏伟, 张忠涛, 代表中国结直肠癌手术病例登记数据库研究者团队
中国实用外科杂志 ›› 2026, Vol. 46 ›› Issue (2) : 239-246.
PDF(1948 KB)
PDF(1948 KB)
中国结直肠癌手术病例登记数据库2025年度报告：一项全国性前瞻性登记研究
Annual report of Chinese Colorectal Cancer Surgery Database in 2025: A nationwide prospective registry study
目的 分析中国结直肠癌手术病例登记数据库（CCCD）自2020年1月升级后纳入的前瞻性登记数据，特别关注直肠癌MRI检查率及新辅助治疗比例等规范化诊治的关键指标，为国内结直肠癌外科治疗策略制定和临床实践提供循证医学证据。方法 前瞻性纳入2020年1月至2025年9月期间CCCD收集的结直肠癌手术病人临床病理学资料，标准化整理后分析其临床特征、外科诊疗方案及术后短期结局。结果 CCCD更新后，共纳入86个医学中心的结直肠癌手术病例19 806例，其中36.0%的病例来自地市级医院。结直肠癌手术病人中，直肠癌（50.2%）比例稍高于结肠癌（49.8%），中、低位直肠癌占所有直肠癌的70.9%。直肠癌病人术前MRI检查及格式化报告的填报率为73.9%。结直肠癌病人术前行新辅助治疗占10.5%，其中结肠癌新辅助治疗占6.7%，直肠癌新辅助治疗占16.0%，中低位直肠癌中16.6%行新辅助治疗。腹腔镜手术占88.7%，其中完全腹腔镜下结直肠手术占48.5%。手术根治性方面，R0手术切除占96.2%，而R2手术切除占2.9%。总体术后并发症发生率为8.4%，吻合口漏是术后最常见的并发症，发生率为2.0%，中低位直肠癌术后吻合口漏发生率为2.9%，其余部位（上段直肠癌及结肠癌）手术后吻合口漏发生率为1.7%。结论 CCCD前瞻性登记研究结果表明，近年来中国结直肠癌手术病人的基线情况、外科诊疗模式呈现动态变化，规范化诊断和治疗程度在提升。未来应重点关注标准化诊疗流程的推广普及及地市级医院诊疗能力提升，进一步优化随访数据采集机制。
Objective To analyze the nationwide prospective registry data included in the China Colorectal Cancer Surgery Database (CCCD) after its upgrade in January 2020, with a particular focus on key indicators such as the MRI examination rate for rectal cancer and the proportion of neoadjuvant therapy, aiming to provide evidence-based medicine support for formulating domestic colorectal surgery treatment strategies and clinical practice. Methods The clinical and pathological data of colorectal cancer surgery patients collected in the CCCD database from January 2020 to September 2025 were included. After standardized collation, a comprehensive analysis of their clinical characteristics, surgical treatment plans, and short-term outcomes was conducted. Results The latest database update included 19,806 colorectal cancer cases from 86 centers, with a participation rate of 36.0% for municipal hospitals. Among colorectal cancer patients, the proportion of rectal cancer (50.2%) was higher than that of colon cancer (49.8%), Nearly 70.9% of rectal cancers were mid-low rectal cancers. The preoperative MRI examination of rectal cancer patients had a “DISTANCE” formatted reporting rate of 73.9%. Of all the colorectal cancer patients, 10.5% received neoadjuvant therapy preoperatively, with specific rates of 6.7% for colon cancer and 16.0% for rectal cancer. Notably, approximately 16.6% of patients with mid-low rectal cancer underwent neoadjuvant treatment. Additionally, the utilization rate of laparoscopic surgery reached 88.7%, among which total laparoscopic colorectal surgeries accounted for 48.5%. In terms of radical surgery, the R0 resection rate was 96.2%, while the R2 resection rate was 2.9%. The overall postoperative complication rate was 8.40%. Anastomotic leakage was identified as the most common major complication, with an incidence of 2.0%. Specifically, the leakage rate following mid-low rectal cancer surgery was 2.9%, whereas the rate for other sites (upper rectal cancer and colon cancer) was 1.7%. Conclusion The latest results from the CCCD database analysis indicate dynamic changes in the baseline situation and surgical treatment patterns of colorectal cancer in China in recent years, with an ongoing improvement in the level of standardized diagnosis and treatment. In the future, attention should be focused on the construction of multi-center standardized treatment protocols and the improvement of diagnostic and treatment capabilities in municipal hospitals, as well as further optimizing the follow-up data collection mechanism.
结直肠癌 / 中国结直肠外科大数据研究协作组 / 中国结直肠癌手术病例登记数据库 / 前瞻性 / 规范化 / 标准化
colorectal cancer / Chinese Task Force of Colorectal Big Data / Chinese Colorectal Cancer Surgery Database / prospective / normalization / standardization
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Despite decreased incidence rates in average-age onset patients in high-income economies, colorectal cancer is the third most diagnosed cancer in the world, with increasing rates in emerging economies. Furthermore, early onset colorectal cancer (age ≤50 years) is of increasing concern globally. Over the past decade, research advances have increased biological knowledge, treatment options, and overall survival rates. The increase in life expectancy is attributed to an increase in effective systemic therapy, improved treatment selection, and expanded locoregional surgical options. Ongoing developments are focused on the role of sphincter preservation, precision oncology for molecular alterations, use of circulating tumour DNA, analysis of the gut microbiome, as well as the role of locoregional strategies for colorectal cancer liver metastases. This overview is to provide a general multidisciplinary perspective of clinical advances in colorectal cancer.Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.
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姚宏伟, 李心翔, 崔龙, 等. 中国结直肠癌手术病例登记数据库2022年度报告: 一项全国性登记研究[J]. 中国实用外科杂志, 2023, 43(1): 93-99. DOI:10.19538/j.cjps.issn1005-2208.2023.01.13.
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姚宏伟, 李心翔, 崔龙, 等. 中国结直肠癌手术病例登记数据库2019年度报告: 一项全国性登记研究[J]. 中国实用外科杂志, 2020, 40(1): 106-110+116. DOI: 10.19538/j.cjps.issn1005-2208.2020.01.19.
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国家卫生健康委员会. 结直肠癌筛查与早诊早治方案(2024年版)[J]. 消化肿瘤杂志(电子版), 2024, 16(4): 410-411. DOI:10.3969/j.issn.1674-7402.2024.04.003.
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Purpose We investigated the correlation between the number of examined lymph nodes (ELNs) and correct staging and long-term survival in non-small-cell lung cancer (NSCLC) by using large databases and determined the minimal threshold for the ELN count. Methods Data from a Chinese multi-institutional registry and the US SEER database on stage I to IIIA resected NSCLC (2001 to 2008) were analyzed for the relationship between the ELN count and stage migration and overall survival (OS) by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural break points were determined by Chow test. The selected cut point was validated with the SEER 2009 cohort. Results Although the distribution of ELN count differed between the Chinese registry (n = 5,706) and the SEER database (n = 38,806; median, 15 versus seven, respectively), both cohorts exhibited significantly proportional increases from N0 to N1 and N2 disease (SEER OR, 1.038; China OR, 1.012; both P <.001) and serial improvements in OS (N0 disease: SEER HR, 0.986; China HR, 0.981; both P <.001; N1 and N2 disease: SEER HR, 0.989; China HR, 0.984; both P <.001) as the ELN count increased after controlling for confounders. Cut point analysis showed a threshold ELN count of 16 in patients with declared node-negative disease, which were examined in the derivation cohorts (SEER 2001 to 2008 HR, 0.830; China HR, 0.738) and validated in the SEER 2009 cohort (HR, 0.837). Conclusion A greater number of ELNs is associated with more-accurate node staging and better long-term survival of resected NSCLC. We recommend 16 ELNs as the cut point for evaluating the quality of LN examination or prognostic stratification postoperatively for patients with declared node-negative disease.
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The Adjuvant Colon Cancer End Points (ACCENT) Collaborative Group was formed 15 years ago to address scientific questions in early stage colon cancer that could best be answered by pooling individual patient data across many randomized clinical trials. Today, the ACCENT database contains detailed information collected from over 40,000 patients enrolled onto 27 major adjuvant colon cancer trials conducted between 1977 and 2009. Since its inception, the ACCENT group has led many sophisticated analyses addressing a variety of clinical questions, such as the long-term survivorship of colon cancer patients by treatment, the time course of oxaliplatin benefit, and support for the use of disease-free survival (DFS) as a surrogate endpoint for overall survival (OS), among many others. Here, we provide an updated overview of recent important results and future directions of the ACCENT collaboration.
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The necessary and sufficient length of the distal resection margin (l-DRM) for rectosigmoid cancer remains controversial. This study evaluated the validity of the 3-cm l-DRM rule for rectosigmoid cancer in the Japanese classification of colorectal cancer.We retrospectively reviewed 1,443 patients with cT3 and cT4 rectosigmoid cancer who underwent R0 resection in Japanese institutions between 1995 and 2004. We identified the optimal cutoff point of the l-DRM affecting overall survival (OS) rate using a multivariate Cox regression analysis model. Using this cutoff point, the patients were divided into two groups after balancing the potential confounding factors of the l-DRM using propensity score matching, and the OS rates of the two groups were compared.A multivariate Cox regression analysis model revealed that the l-DRM of 4 cm was the best cutoff point with the greatest impact on OS rate (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.00-1.84; P = 0.0452) and with the lowest Akaike information criterion value. In the matched cohort study, the OS rate of patients who had l-DRM of 4 cm or more was significantly higher than that of patients who had l-DRM < 4 cm (n = 402; 5-year OS rates, 87.6% vs. 80.3%, respectively; HR, 1.60; 95% CI, 1.09-2.31; P = 0.0136).For cT3 and cT4 rectosigmoid cancer, l-DRM of 4 cm may be an appropriate landmark for a curative intent surgery, and we were unable to definitively confirm the validity of the Japanese 3-cm l-DRM rule.Copyright © 2020 by The Japan Society of Coloproctology.
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Hereditary colorectal cancer (HCRC) accounts for < 5% of all colorectal cancer cases. Some of the unique characteristics commonly encountered in HCRC cases include early age of onset, synchronous/metachronous cancer occurrence, and multiple cancers in other organs. These characteristics necessitate different management approaches, including diagnosis, treatment or surveillance, from sporadic colorectal cancer management. There are two representative HCRC, named familial adenomatous polyposis and Lynch syndrome. Other than these two HCRC syndromes, related disorders have also been reported. Several guidelines for hereditary disorders have already been published worldwide. In Japan, the first guideline for HCRC was prepared by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), published in 2012 and revised in 2016. This revised version of the guideline was immediately translated into English and published in 2017. Since then, several new findings and novel disease concepts related to HCRC have been discovered. The currently diagnosed HCRC rate in daily clinical practice is relatively low; however, this is predicted to increase in the era of cancer genomic medicine, with the advancement of cancer multi-gene panel testing or whole genome testing, among others. Under these circumstances, the JSCCR guidelines 2020 for HCRC were prepared by consensus among members of the JSCCR HCRC Guideline Committee, based on a careful review of the evidence retrieved from literature searches, and considering the medical health insurance system and actual clinical practice settings in Japan. Herein, we present the English version of the JSCCR guidelines 2020 for HCRC.
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The number of deaths from colorectal cancer in Japan continues to increase. Colorectal cancer deaths exceeded 50,000 in 2016. In the 2019 edition, revision of all aspects of treatments was performed, with corrections and additions made based on knowledge acquired since the 2016 version (drug therapy) and the 2014 version (other treatments). The Japanese Society for Cancer of the Colon and Rectum guidelines 2019 for the treatment of colorectal cancer (JSCCR guidelines 2019) have been prepared to show standard treatment strategies for colorectal cancer, to eliminate disparities among institutions in terms of treatment, to eliminate unnecessary treatment and insufficient treatment and to deepen mutual understanding between healthcare professionals and patients by making these guidelines available to the general public. These guidelines have been prepared by consensuses reached by the JSCCR Guideline Committee, based on a careful review of the evidence retrieved by literature searches and in view of the medical health insurance system and actual clinical practice settings in Japan. Therefore, these guidelines can be used as a tool for treating colorectal cancer in actual clinical practice settings. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. Controversial issues were selected as clinical questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSCCR guidelines 2019.
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李杨, 任明扬, 张宏宇, 等. 经肛全直肠系膜切除术中困难或意外及术后并发症发生情况调查报告(一项基于全国性登记数据库的研究)[J]. 中国实用外科杂志, 2022, 42(11): 1260-1264. DOI:10.19538/j.cjps.issn1005-2208.2022.11.14.
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Transanal total mesorectal resection (taTME) has recently emerged as a promising surgical approach for the treatment of mid-low rectal cancer. However, there is limited evidence on the long-term survival outcomes associated with taTME. This retrospective study aimed to compare the overall survival (OS), disease-free survival (DFS), and cancer-specific survival of taTME and laparoscopic TME (laTME) in patients with mid-low rectal cancer.
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Previous studies have demonstrated the advantages of short-term histopathological outcomes and complications associated with transanal total mesorectal excision (TME) compared with laparoscopic TME. However, the long-term oncological outcomes of transanal TME remain ambiguous. This study aims to compare 3-year disease-free survival of transanal TME with laparoscopic TME.To evaluate 3-year disease-free survival between transanal TME and laparoscopic TME in patients with rectal cancer.This randomized, open-label, noninferiority, phase 3 clinical trial was performed in 16 different centers in China. Between April 2016 and June 2021, a total of 1115 patients with clinical stage I to III mid-low rectal cancer were enrolled. The last date of participant follow-up was in June 2024.Participants were randomly assigned in a 1:1 ratio before their surgical procedure to undergo either transanal TME (n = 558) or laparoscopic TME (n = 557).The primary end point was 3-year disease-free survival, with a noninferiority margin of -10% for the comparison between transanal TME and laparoscopic TME. Secondary outcomes included 3-year overall survival and 3-year local recurrence.In the primary analysis set, the median patient age was 60 years. A total of 692 male and 397 female patients were included in the analysis. Three-year disease-free survival was 82.1% (97.5% CI, 78.4%-85.8%) for the transanal TME group and 79.4% (97.5% CI, 75.6%-83.4%) for the laparoscopic TME group, with a difference of 2.7% (97.5% CI, -3.0% to 8.1%). The lower tail of a 2-tailed 97.5% CI for the group difference in 3-year disease-free survival was above the noninferiority margin of -10 percentage points. Furthermore, the 3-year local recurrence was 3.6% (95% CI, 2.0%-5.1%) for transanal TME and 4.4% (95% CI, 2.6%-6.1%) for laparoscopic TME. Three-year overall survival was 92.6% (95% CI, 90.4%-94.8%) for transanal TME and 90.7% (95% CI, 88.3%-93.2%) for laparoscopic TME.In patients with mid-low rectal cancer, 3-year disease-free survival for transanal TME was noninferior to that of laparoscopic TME.ClinicalTrials.gov Identifier: NCT02966483.
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姚宏伟, 张宏宇, 任明扬, 等. 经肛全直肠系膜切除术后病理标本环周切缘阳性危险因素分析:基于全国性病例登记数据库805例直肠癌研究结果[J]. 中国实用外科杂志, 2020, 40(1): 111-116. DOI:10.19538/j.cjps.issn1005-2208.2020.01.20.
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Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of rectal MRI and increased radiologist awareness of the key rectal cancer TNM staging features, the mortality rate of rectal cancer has been declining over the past few decades in adults over 50 years of age. Currently, rectal MRI plays a key role in the pre- and posttreatment evaluation of rectal cancer, assisting the multidisciplinary team in tailoring the most appropriate treatment option. The benefits achieved with rectal MRI are strictly dependent on obtaining good-quality images, which is important for the characterization of the main anatomic structures and their relationship with the tumor. In primary staging, rectal MRI helps the radiologist (a) describe the tumor location and morphology, (b) provide its T and N categories, (c) detect the presence of extramural vascular invasion, and (d) identify its relationship with surrounding structures, including the sphincter complex and involvement of the mesorectal fascia. These features help diagnose locally advanced rectal tumors (categories T3c-d, T4, N1, and N2), for which neoadjuvant chemoradiotherapy (CRT) is indicated. In restaging after neoadjuvant CRT, in addition to reassessing the features noted during primary staging, rectal MRI can help in the assessment of treatment response, especially with the emergence of nonsurgical approaches such as "watch and wait." RSNA, 2019.
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Mesorectal fascia involvement caused by tumor deposits or extramural vascular invasion at pretreatment MRI predicts poor prognosis in patients with locally advanced rectal cancer.
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Although neoadjuvant immunotherapy showed promising efficacy in locally advanced microsatellite instability-high or mismatch repair-deficient (MSI-H/dMMR) colon cancer, whether dual immune checkpoint inhibition provides additional benefit over anti-PD-1 monotherapy remains unclear. This randomized phase 1b trial (NCT05890742) evaluated a neoadjuvant regimen of IBI310 (anti-cytotoxic T lymphocyte-associated antigen 4 [CTLA-4]) plus sintilimab (n = 52) versus sintilimab monotherapy (n = 49). Surgery was performed in 51 and 45 patients, respectively. The primary endpoint, pathological complete response (pCR) rate, was significantly higher in the combination compared to the monotherapy arm within the modified intent-to-treat (mITT) population (78.4% versus 46.7%, p = 0.0015), with consistent results in the intent-to-treat (ITT) population (76.9% versus 42.9%). Safety in both arms was comparable and manageable without new safety signals. After a median follow-up of 21.4 months, no disease recurrences occurred. One death occurred in each arm due to postoperative complication and adverse events. These findings demonstrate the added benefit of neoadjuvant IBI310 plus sintilimab over sintilimab monotherapy for locally advanced MSI-H/dMMR colon cancer.Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
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Neoadjuvant short-course radiotherapy (SCRT) followed by CAPOX and camrelizumab (a programmed cell death protein 1 monoclonal antibody) has shown potential clinical activity for locally advanced rectal cancer (LARC) in a phase II trial. This study aimed to further confirm the efficacy and safety of SCRT followed by CAPOX and camrelizumab compared to long-course chemoradiotherapy (LCRT) followed by CAPOX alone as neoadjuvant treatment for LARC.In this randomized, phase III trial, patients with T3-4/N+ rectal adenocarcinoma were randomly assigned (1 : 1) to receive SCRT or long-course chemoradiotherapy (LCRT), followed by two cycles of camrelizumab and CAPOX or CAPOX alone, respectively. After surgery, each arm underwent either six cycles of camrelizumab and CAPOX, followed by up to 17 doses of camrelizumab, or six cycles of CAPOX. The primary endpoint was pathological complete response (pCR) rate (ypT0N0) assessed by a blinded independent review committee. Key secondary endpoints tested hierarchically were 3-year event-free survival (EFS) rate and overall survival (OS).Between July 2021 and March 2023, the intention-to-treat population comprised 113 patients in the experimental arm and 118 patients in the control arm, with surgery carried out in 92% and 83.9%, respectively. At data cut-off (11 July 2023), the pCR rates were 39.8% [95% confidence interval (CI) 30.7% to 49.5%] in the experimental arm compared to 15.3% (95% CI 9.3% to 23.0%) in the control arm (difference, 24.6%; odds ratio, 3.7; 95% CI 2.0-6.9; P < 0.001). In each arm, surgical complication rates were 40.0% and 40.8%, and grade ≥3 treatment-related adverse events were 29.2% and 27.2%. Three-year EFS rate and OS continue to mature.In LARC patients, neoadjuvant SCRT followed by camrelizumab plus CAPOX demonstrated a significantly higher pCR rate than LCRT followed by CAPOX, with a well-tolerated safety profile. SCRT followed by camrelizumab and chemotherapy can be recommended as a neoadjuvant treatment modality for these patients.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Anastomotic leakage after restorative surgery for rectal cancer shows high morbidity and related mortality. Identification of risk factors could change operative planning, with indications for stoma construction. This retrospective multicentre study aims to assess the anastomotic leak rate, identify the independent risk factors and develop a clinical prediction model to calculate the probability of leakage.
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Anastomotic leakage after sphincter-preserving proctectomy is a serious postoperative complication. It is unclear whether diverting ostomy prevents anastomotic leakage, and whether anastomotic leakage worsens long-term oncologic outcomes.Data from patients with stage II-III mid/low rectal cancer who underwent sphincter-preserving proctectomy between January 2010 and December 2011 were retrospectively analyzed using a multicenter database from 69 institutions. Factors associated with anastomotic leakage and its influence on oncologic outcomes were evaluated.A total of 922 patients were included. Anastomotic leakage was diagnosed in 125 patients (13.6%). Anastomotic leakage was associated with increased reoperations (29.6% vs. 1.0%, p < 0.0001), longer hospital stays (median 34 days vs. 15 days, p < 0.0001), and more frequent permanent ostomy (20.8% vs. 11.0%, p = 0.002). Multivariable analysis revealed that absence of diverting ostomy (odds ratio 2.46, 95% confidential interval 1.59-3.85, p = 0.0004) and male sex (odds ratio 2.54, 95% confidence interval 1.58-4.26, p = 0.001) were independently associated with an increased risk of anastomotic leakage. The risk reduction with diverting ostomy was observed in both sexes in interaction term analysis. Anastomotic leakage was associated with an increased risk of local recurrence in patients with pathologic stage III disease (hazard ratio 2.11, 95% confidence interval 1.08-4.14, p = 0.03) but was not associated with overall or recurrence-free survival.Absence of diverting ostomy and male sex were risk factors for anastomotic leakage, and anastomotic leakage was associated with increased local recurrence in patients with stage III disease. These findings support the practice of protective diversion after sphincter-preserving proctectomy in patients with mid/low rectal cancer.© 2025. Society of Surgical Oncology.
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Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy.To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer.Randomized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries, including 40 surgeons. Recruitment of patients was from January 7, 2011, to September 30, 2014, follow-up was conducted at 30 days and 6 months, and final follow-up was on June 16, 2015.Patients were randomized to robotic-assisted (n = 237) or conventional (n = 234) laparoscopic rectal cancer resection, performed by either high (upper rectum) or low (total rectum) anterior resection or abdominoperineal resection (rectum and perineum).The primary outcome was conversion to open laparotomy. Secondary end points included intraoperative and postoperative complications, circumferential resection margin positivity (CRM+) and other pathological outcomes, quality of life (36-Item Short Form Survey and 20-item Multidimensional Fatigue Inventory), bladder and sexual dysfunction (International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index), and oncological outcomes.Among 471 randomized patients (mean [SD] age, 64.9 [11.0] years; 320 [67.9%] men), 466 (98.9%) completed the study. The overall rate of conversion to open laparotomy was 10.1%: 19 of 236 patients (8.1%) in the robotic-assisted laparoscopic group and 28 of 230 patients (12.2%) in the conventional laparoscopic group (unadjusted risk difference = 4.1% [95% CI, -1.4% to 9.6%]; adjusted odds ratio = 0.61 [95% CI, 0.31 to 1.21]; P = .16). The overall CRM+ rate was 5.7%; CRM+ occurred in 14 (6.3%) of 224 patients in the conventional laparoscopic group and 12 (5.1%) of 235 patients in the robotic-assisted laparoscopic group (unadjusted risk difference = 1.1% [95% CI, -3.1% to 5.4%]; adjusted odds ratio = 0.78 [95% CI, 0.35 to 1.76]; P = .56). Of the other 8 reported prespecified secondary end points, including intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction, none showed a statistically significant difference between groups.Among patients with rectal adenocarcinoma suitable for curative resection, robotic-assisted laparoscopic surgery, as compared with conventional laparoscopic surgery, did not significantly reduce the risk of conversion to open laparotomy. These findings suggest that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic surgery, does not confer an advantage in rectal cancer resection.isrctn.org Identifier: ISRCTN80500123.
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This study aims to report short-term clinical and oncological outcomes from the international transanal Total Mesorectal Excision (taTME) registry for benign and malignant rectal pathology.TaTME is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. Outcomes have been published from small cohorts, but larger series can further assess the safety and efficacy of taTME in the wider surgical population.Data were analyzed from 66 registered units in 23 countries. The primary endpoint was "good-quality TME surgery." Secondary endpoints were short-term adverse events. Univariate and multivariate regression analyses were used to identify independent predictors of poor specimen outcome.A total of 720 consecutively registered cases were analyzed comprising 634 patients with rectal cancer and 86 with benign pathology. Approximately, 67% were males with mean BMI 26.5 kg/m. Abdominal or perineal conversion was 6.3% and 2.8%, respectively. Intact TME specimens were achieved in 85%, with minor defects in 11% and major defects in 4%. R1 resection rate was 2.7%. Postoperative mortality and morbidity were 0.5% and 32.6% respectively. Risk factors for poor specimen outcome (suboptimal TME specimen, perforation, and/or R1 resection) on multivariate analysis were positive CRM on staging MRI, low rectal tumor <2 cm from anorectal junction, and laparoscopic transabdominal posterior dissection to <4 cm from anal verge.TaTME appears to be an oncologically safe and effective technique for distal mesorectal dissection with acceptable short-term patient outcomes and good specimen quality. Ongoing structured training and the upcoming randomized controlled trials are needed to assess the technique further.
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