PMID- 34537862
OWN - NLM
STAT- MEDLINE
DCOM- 20211116
LR  - 20220218
IS  - 1432-1262 (Electronic)
IS  - 0179-1958 (Print)
IS  - 0179-1958 (Linking)
VI  - 36
IP  - 12
DP  - 2021 Dec
TI  - Robotic versus transanal total mesorectal excision in sexual, anorectal, and 
      urinary function: a multicenter, prospective, observational study.
PG  - 2749-2761
LID - 10.1007/s00384-021-04030-5 [doi]
AB  - PURPOSE: Improved long-term survival after low anterior resection (LAR) for 
      rectal cancer highlights the importance of functional outcome. Urogenital and 
      anorectal dysfunction is frequently reported after conventional LAR. Advanced 
      minimally invasive techniques such as robotic (RoTME) and transanal total 
      mesorectal excision (TaTME) might improve functional results by precisely 
      dissecting and preserving autonomic nerves. We compared functional outcomes after 
      RoTME or TaTME in a multicenter study. METHODS: One hundred twenty patients (55 
      RoTME/65 TaTME) were prospectively included in four participating centers. 
      Anorectal (Wexner and low anterior resection syndrome (LARS) Score), urinary 
      (International Consultation on Incontinence-Male/Female Lower Urinary Tract 
      Symptoms Score (ICIQ-MLUTS/ICIQ-FLUTS) and International Prostate Symptom Scale 
      (IPSS)), and sexual (International Index of Erectile Function (IIEF), Female 
      Sexual Function Index (FSFI)) outcomes at 12 months after surgery were compared 
      to preoperative scores. The response rate to the 1-year postoperative functional 
      assessment by questionnaire was 79.5%. RESULTS: RoTME enabled better anorectal 
      function compared to TaTME (LARS score 4.3 +/- 2.2 vs. 9.8 +/- 1.5, p = 0.038, 
      respectively). TaTME proved superior at preserving male urinary function, while 
      female urinary function was comparable in both groups, with only mild 
      postoperative impairment (RoTME vs. TaTME, respectively: ICIQ-MLUTS 13.8 +/- 4.9 
      vs. 1.8 +/- 5.8, p = 0.038; ICIQ-FLUTS Incontinence Score - 0.3 +/- 1.0 
      vs. - 0.2 +/- 0.9, p = 0.844). Both techniques demonstrated comparable male 
      (RoTME - 13.4 +/- 2.7 vs. TaTME - 11.7 +/- 3.4, p = 0.615) and female (RoTME 
      5.2 +/- 4.6 vs. TaTME 10.5 +/- 6.4, p = 0.254) sexual function. CONCLUSION: After 
      adjustment for risk factors, RoTME provided better anorectal functional results, 
      whereas TaTME was better at preserving male urinary function. Overall, both 
      techniques demonstrated only mild postoperative functional impairment.
CI  - (c) 2021. The Author(s).
FAU - Grass, Julia-Kristin
AU  - Grass JK
AUID- ORCID: 0000-0003-4561-0841
AD  - Department of General, Visceral and Thoracic Surgery, University Medical Centre 
      of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. j.grass@uke.de.
FAU - Persiani, Roberto
AU  - Persiani R
AD  - Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del 
      Sacro Cuore, Rome, Italy.
FAU - Tirelli, Flavio
AU  - Tirelli F
AD  - Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del 
      Sacro Cuore, Rome, Italy.
FAU - Chen, Chien-Chih
AU  - Chen CC
AD  - Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
AD  - College of Medicine, National Yang-Ming University, Taipei, Taiwan.
FAU - Caricato, Marco
AU  - Caricato M
AD  - Colorectal Surgery Unit, Universita Campus Bio-Medico, Rome, Italy.
FAU - Pecorino, Alice
AU  - Pecorino A
AD  - Colorectal Surgery Unit, Universita Campus Bio-Medico, Rome, Italy.
FAU - Lang, Isabelle J
AU  - Lang IJ
AD  - Department of General, Visceral and Thoracic Surgery, University Medical Centre 
      of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
FAU - Kemper, Marius
AU  - Kemper M
AD  - Department of General, Visceral and Thoracic Surgery, University Medical Centre 
      of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
FAU - Izbicki, Jakob R
AU  - Izbicki JR
AD  - Department of General, Visceral and Thoracic Surgery, University Medical Centre 
      of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
FAU - Melling, Nathaniel
AU  - Melling N
AD  - Department of General, Visceral and Thoracic Surgery, University Medical Centre 
      of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
FAU - Perez, Daniel
AU  - Perez D
AD  - Department of General, Visceral and Thoracic Surgery, University Medical Centre 
      of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20210918
PL  - Germany
TA  - Int J Colorectal Dis
JT  - International journal of colorectal disease
JID - 8607899
SB  - IM
MH  - Female
MH  - Humans
MH  - *Laparoscopy
MH  - Male
MH  - Postoperative Complications/etiology
MH  - Prospective Studies
MH  - *Rectal Neoplasms/surgery
MH  - Rectum/surgery
MH  - *Robotic Surgical Procedures/adverse effects
MH  - Syndrome
MH  - *Transanal Endoscopic Surgery
MH  - Treatment Outcome
PMC - PMC8589758
OTO - NOTNLM
OT  - Functional outcome
OT  - Low anterior resection syndrome
OT  - Robotic total mesorectal excision
OT  - Transanal total mesorectal excision
OT  - Urogenital function
COIS- DP is proctor for Intuitive Surgical and has received honoraria. All other 
      authors declare no conflicts of interest.
EDAT- 2021/09/20 06:00
MHDA- 2021/11/17 06:00
PMCR- 2021/09/18
CRDT- 2021/09/19 20:52
PHST- 2021/09/11 00:00 [accepted]
PHST- 2021/09/20 06:00 [pubmed]
PHST- 2021/11/17 06:00 [medline]
PHST- 2021/09/19 20:52 [entrez]
PHST- 2021/09/18 00:00 [pmc-release]
AID - 10.1007/s00384-021-04030-5 [pii]
AID - 4030 [pii]
AID - 10.1007/s00384-021-04030-5 [doi]
PST - ppublish
SO  - Int J Colorectal Dis. 2021 Dec;36(12):2749-2761. doi: 10.1007/s00384-021-04030-5. 
      Epub 2021 Sep 18.