Robotic Beyond Total Mesorectal Excision (bTME) for locally advanced and recurrent anorectal cancer: a systematic review.

Abstract

Robotic surgery is increasingly utilized for rectal cancer resection, particularly in cases requiring beyond total mesorectal excision (bTME) to achieve oncological clearance. Despite longer operative times, robotic bTME has been associated with reduced morbidity and blood loss, making it an emerging approach in specialized centers. A systematic review following PRISMA guidelines was conducted in Web of Science, PubMed, and Scopus. Studies reporting robotic bTME for recurrent or locally advanced anorectal cancer were included. Outcomes assessed included study characteristics, demographics, operative outcomes, oncological data, and follow-up. Nineteen studies comprising 1027 patients met the inclusion criteria (13 case series-68% and 6 cohort studies-32%). The median patient age ranged from 51 to 68 years with 73.7% males. Most patients had an ASA score of 2 (53.1%), and BMI ranged from 21.1 to 28.6. Tumor locations were predominantly near the anal verge (median: 3-6 cm), and the most common clinical staging was cT3, cN1, and cM0. Surgical complications included urinary issues (22.6%), anastomotic leakage (11.4%), ileus (10.4%), and bleeding (5.3%). Follow-up data indicated a recurrence rate of 24.9%, and the 1-year survival rate was > 90%. These studies reported an overall complication rate of 49.7%, with a median follow-up of 12-36 months. Oncological outcomes were favorable, although there was significant variability in survival data between studies. The heterogenicity of the studies makes it challenging to conclusively establish robotic bTME as a feasible alternative to the gold standard. Further prospective studies, with measurable outcomes and consistent terminology, are needed to ensure homogeneity.