经肛门全直肠系膜切除和腹腔镜全直肠系膜切除对直肠癌的疗效对比

目的分析比较经肛门全直肠系膜切除（TaTME）与腹腔镜全直肠系膜切除（LaTME）在中低位直肠癌治疗中的疗效及预后。 方法选择东营市东营区人民医院2015年2月至2016年2月收治的64例择期行全直肠系膜切除术（TME）的中低位直肠癌患者，随机分为TaTME组与LaTME组，各32例。观察并比较两组患者的手术时间、术中出血量、标本完整率、环周切缘（CRM）阳性率、远端切缘（DRM）阴性率、淋巴结清扫数目、保肛率、中转开放手术率、术中及术后并发症、术后住院时间、局部复发率、远处转移率、2年总体生存率（OS）各指标间的差异。 结果TaTME组患者的术中出血量、中转开放手术率、手术时间、标本完整率、CRM阳性率、保肛率、术后住院时间、尿潴留发生率均显著优于LaTME组（均P<0.05）。患者均获随访2~24个月，TaTME组中位生存时间为23.9个月，局部复发率、转移率分别为6.2%（2/32）、3.1%（1/32）。LaTME组中位生存时间为19.7个月，局部复发率、转移率均为3.1%（1/32）。两组术后复发率、转移率比较，差异无统计学意义（χ²=0.350、0.516，P=0.554、0.472）。TaTME组与LaTME组1年OS分别为100.00%、93.75%，2年OS分别为96.87%、81.25%。两组1年OS比较，差异无统计学意义（χ²=0.516，P=0.472），TaTME组的2年OS显著高于LaTME组患者（χ²=4.402，P=0.036）。 结论与LaTME术相比，TaTME术治疗中低位直肠癌具有较高的安全性和有效性，且术后并发症较少，术后住院时间短，可以改善患者预后。     

经肛门与传统腹腔镜全系膜切除术在中低位直肠癌中可行性与安全性的Meta分析

目的系统性评价经肛门全直肠系膜切除（TaTME）与腹腔镜全直肠系膜切除（LaTME）治疗中低位直肠癌的术中、术后指标，并发症及其病理学结果，分析TaTME术式可行性及安全性。 方法通过检索Pubmed、EMBase、Cochrane Library、中国知网、万方、重庆维普国内外大型数据库，筛选2015年2月至2019年4月间发表的关于TaTME与LaTME治疗中低位直肠癌的相关文献。文献质量标准采用纽卡斯尔-渥太华量表（NOS），采用Revman 5.3软件进行Meta分析，敏感性分析异质性结果。 结果共13篇文献1 096例患者符合纳入标准，包括TaTME组515例，LaTME组581例。与LaTME组相比，TaTME组具有高质量的CRM距离（MD=0.95，95%CI=0.61~1.29，P<0.001），低CRM阳性率（OR=0.35，95%CI=0.16~0.78，P=0.010），高质量的全直肠系膜切除（OR=2.41，95%CI=1.29~4.51，P=0.006），低中转开腹率（OR=0.20，95%CI=0.07~0.58，P=0.003），Clavien-Dindo分级3级及以上术后并发症发生率（OR=0.54，95%CI=0.32~0.92，P=0.020）、术后排尿障碍发生率低（OR=0.54，95%CI=0.31~0.94，P=0.030）及低非计划性二次入院率（OR=0.44，95%CI=0.27~0.73，P=0.001）。两组在DRM阳性率及切除距离、淋巴结清扫数量、术中失血量、手术持续时间以及总并发症、肠梗阻、吻合口瘘发生率等方面差异无统计学意义。 结论相较于LaTME术式，TaTME治疗中低位直肠癌可以得到更高质量的标本，术后危重并发症发生率明显降低，术式可行且安全。     

腹腔镜全直肠系膜切除术与经肛门全直肠系膜切除术治疗中低位直肠癌的疗效与安全性Meta分析

背景与目的 尽管腹腔镜全直肠系膜切除术（LaTME）已广泛应用于直肠癌的治疗，但仍有其技术障碍，经肛门全直肠系膜切除术（TaTME）能够克服LaTME的缺点，在中低位直肠癌治疗中具有一定优势。然而，目前对TaTME的疗效与安全性仍有一些争议。因此，本研究通过Meta分析的方法比较TaTME与LaTME的近期疗效与安全性，为临床提供循证参考。方法 检索多个国内外数据库中有关TaTME与LaTME在中低位直肠癌治疗中比较研究。对纳入的文献提取资料及进行质量评价，采用Revman5.3软件行Meta分析。结果 共纳入18项对照研究，包含2 334例直肠癌的患者，其中TaTME组1 133例，LaTME组1 201例。Meta分析结果显示，TaTME组环周切缘（CRM）阳性率低于LaTME组（OR=0.58，95% CI=0.40~0.83，P=0.003），中转开放手术率低于LaTME组（OR=0.18，95% CI=0.11~0.31，P<0.000 01），术后住院时间短于LaTME组（WMD=-1.51，95% CI =-2.70~-0.33，P=0.01），R₁切除率低于LaTME组（OR=0.30，95% CI=0.15~0.60，P=0.000 7）。两组收获的淋巴结数量、手术时间、术中出血量、直肠系膜切除完整度，CRM距离、远端切缘（DRM）阳性率、DRM距离、吻合口瘘发生率、肠梗阻发生率差异均无统计学意义（均P>0.05）。结论 在严格的手术适应证下，TaTME治疗中、低位直肠癌的安全性不亚于LaTME，且能达到更好的肿瘤学根治效果。但以上结论仍需要纳入更多的高质量研究加以验证。     

经肛门与腹腔镜全直肠系膜切除术治疗低位直肠癌的应用对比研究

目的对比经肛门全直肠系膜切除术（TaTME）与传统腹腔镜全直肠系膜切除术（LaTME）两种术式在低位直肠癌治疗中的病理特征和临床治疗效果。 方法回顾性分析2015年1月至2020年9月中山市人民医院收治的100例低位直肠癌患者,根据治疗方式被分为TaTME组（接受TaTME）和LaTME组（接受LaTME）,每组50例。所有手术切除标本均进行组织病理学检查。术后随访1年,统计分析两组相关指标差异：环周切缘阳性率（CRM+）、远端切缘阳性率（DRM+）、淋巴结阳性率,平均手术时间、出血量、住院时间、肠道功能恢复时间,保肛率和吻合口瘘发生率。 结果患者均手术顺利,TaTME组的CRM+、DRM+分别为（10±2）%、（8±4）%,与LaTME组的（8±2）%、（6±1）%相比,差异无统计学意义。TaTME组的淋巴结检测阳性率（80±6）%,高于LaTME组的（60±8）%（P=0.041）。TaTME组的平均手术时间（160±35）min和保肛率（80±10）%,均高于LaTME组的（120±26）min、（40±8）%（P<0.001）。TaTME组术中出血量、住院时间、肠道功能恢复时间均低于LaTME组（P<0.001）,术后随访1年TaTME组吻合口瘘发生率低于LaTME组（P=0.043）。 结论TaTME在低位直肠癌患者的治疗中具有显著优势,相对于LaTME可显著提高保肛率,降低并发症的发生。     

Transanal total mesorectal excision achieves equivalent oncologic resection compared to laparoscopic approach,but with functional consequences

BackgroundThis study compared transanal total mesorectal excision (taTME) to laparoscopic total mesorectal excision (laTME) for the treatment of low rectal cancer. Adequacy of oncologic resection as well as postoperative outcomes were analyzed.MethodsWe retrospectively reviewed all proctectomy for low rectal cancer by a single surgeon at our institution from January 2014 to September 2019.ResultsThere were 20 taTME and 30 laTME patients. TaTME patients had more distal tumors with no difference in pathologic resection margins or frequency of positive distal margin. Operative times were longer for taTME, but there were no differences in short-term outcomes or complications. TaTME patients had a higher rate of postoperative fecal incontinence.ConclusionTaTME may be a good option for the most distal tumors, when distal margins may be compromised. TaTME provides equivalent oncologic resection, but there is a higher incidence of postoperative fecal incontinence.     

Anastomotic leakage and chronic presacral sinus after transanal total mesorectal excision (taTME) for rectal cancer: A comparative study to laparoscopic TME

BackgroundSeveral studies have shown that there are no significant differences in anastomotic leakage associated with Transanal total mesorectal excision (taTME) versus laparoscopic TME (lapTME) for rectal cancer; however, little is known about late anastomotic leakage, such as that primarily found in the chronic presacral sinus. We aimed to compare the occurrence of anastomotic leakage and chronic presacral sinus in rectal cancer for taTME and lapTME.MethodsIn this retrospective cohort study, data were collected for patients with rectal cancer who underwent surgery between January 2009 and September 2019. Of the 220 patients included in this study, 182 were in the lapTME group and 38 in the taTME group. We compared factors associated with anastomotic leakage and chronic presacral sinus formation between the two groups. A binary-logistic model was used to determine the risk factors for chronic presacral sinus.ResultsAnastomotic leakage occurred in six patients (15.8%) in the taTME group and 36 patients (19.7%) in the lapTME group. Chronic presacral sinus occurred in three patients (7.9%) in the taTME group and 15 patients (8.2%) in the lapTME group. There was no significant difference in anastomotic leakage or chronic presacral sinus between groups (P = 0.569 and P = 1.000, respectively). Pathologic stage III or higher was significantly associated with chronic presacral sinus formation (P = 0.006).ConclusionThere were no significant differences between taTME and lapTME regarding the incidence of anastomotic leakage or chronic presacral sinus. Almost one-third of anastomotic leakages developed into chronic presacral sinus.     

Transanal total mesorectal excision as a surgical procedure for diffuse cavernous hemangioma of the rectum: A case report

BackgroundThe safety and feasibility of transanal total mesorectal excision (TaTME) were demonstrated in the management of rectal cancer. However, its role in the management of patients with diffuse cavernous hemangioma of the rectum (DCHR) has not been evaluated.MethodsA female patient with DCHR was admitted to our hospital. Colonoscopy, magnetic resonance imaging (MRI), abdominal computed tomography (CT) and arteriography were performed. Lesions were detected in mesorectum and rectal wall extending from the dentate line to 5 cm proximally. TaTME with a protecting loop ileostomy were performed. The research work has been reported in line with the SCARE criteria Agha et al., 2016 [1].ResultsTaTME and a protecting loop ileostomy were safely performed, with an intact mesorectal specimen being harvested. The entire procedure took 348 min. The estimated blood loss was 100 ml. The patient recovered uneventfully. Her symptom of painless rectal bleeding was resolved satisfactorily following the surgery. The histopathological evaluation confirmed the diagnosis of DCHR.ConclusionsTaTME appears to be a safe and feasible procedure for patients with DCHR in experienced hands.     

Evolution of transanal total mesorectal excision for rectal cancer:From top to bottom

The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.     

经肛门全直肠系膜切除术研究进展

低位直肠癌的治疗方式不仅仅要考虑肿瘤的完整切除,保留肛门生理功能也是一个至关重要的问题。随着对直肠肛管以及盆底肌肉神经局部解剖生理研究的深入,伴随医疗技术的进步,针对低位直肠癌保肛的各种手术方式应运而生,目前较为成熟的手术方式主要有结肠肛管吻合术（Parks术）、经括约肌间切除术（ISR）、经肛门全直肠系膜切除术（TaTME）等。其中,TaTME是体现经自然腔道内镜外科手术（NOTES）的一种理念和手术方式。目前关于TaTME在直肠恶性肿瘤中应用的安全性及有效性在国际上尚存在一定争议,本综述旨在通过查阅国内外现有关于TaTME的相关文献,总结探讨TaTME在低位直肠癌治疗中的安全性、有效性以及未来的发展趋势。     

低位直肠癌完全经肛门全直肠系膜切除术10例

目的探讨完全经肛门全直肠系膜切除术治疗低位直肠癌的可行性与安全性以及手术经验分享。方法回顾收集2015年1月至2016年2月于昆明医科大学第二附属医院行完全经肛门全直肠系膜切除术10例病人术前术后临床资料。结果 10例病人中女性7例,男性3例,年龄(54.8±7.4)岁,10例病人手术顺利完成,无一例中转开腹或腹腔镜辅助。手术时间为(224.00±34.46)min,术中出血为(101.00±34.43)ml,术后通气时间为(1.60±0.70)d,术后拔除引流管时间为(3.40±0.52)d,术后下床活动时间为(2.20±0.42)d,术后住院时间为(9.70±1.77)d,术后均无切口感染、腹腔出血、肠梗阻、肺部感染。结论完全经肛门全直肠系膜切除术具有疗效好、创伤小、生活质量高,对于合适的病人能取到良好的效果。但目前病例数较少,缺乏相关对比分析,仍在探索中。     

多学科团队诊断与治疗模式在规范开展经肛全直肠系膜切除术中的应用价值

经肛全直肠系膜切除术(TaTME)是治疗低位直肠癌的一种新兴手术方式,其以远端直肠手术良好的视野显露和超低位保肛等优势得到认可和推广。目前国内外相关诊断与治疗指南均推荐直肠癌的治疗需要经多学科团队(MDT)讨论决定。MDT已成为直肠癌患者得到规范化治疗的制度性诊断与治疗模式。直肠癌TaTME手术适应证的选择依赖MDT模式下术前影像学检查精准分层、复发危险度判断。规范的MDT术前评估、多学科研讨作出决策是TaTME获得规范化实施和合理推广的保障。同时,TaTME作为一种可能改善直肠肿瘤疗效的手术方式,使部分患者在基于影像学检查准确分期的基础上免去术前放化疗,从而调整外科手术在MDT模式中的地位,为优化直肠癌整体疗效和卫生经济学做出贡献。     

单孔腹腔镜辅助经肛门全直肠系膜切除临床应用价值及展望

经肛门全直肠系膜切除（TaTME）已成为近年来直肠癌手术领域的新热点。由于该新兴技术尚未完全成熟,目前,绝大多数的TaTME均需在腹腔镜辅助下方能完成。出于完全单孔腹腔镜直肠癌手术技术难度大以及传统多孔腹腔镜辅助的TaTME微创优势不明显的考虑,在预定回肠造口位置引入单孔腹腔镜进行辅助的TaTME术式被认为可实现技术难度、微创和手术切除质量三者间的最佳平衡。     

Robotic total mesorectal excision for rectal cancer using four robotic arms

Background The da Vinci system is a newly developed device for colorectal surgery, therefore experience of its use for rectal cancer surgery is limited and there are no reports describing the use of four robotic arms with this system. The aim of this study is to evaluate the safety and feasibility of the four-arm da Vinci system for total mesorectal excision in rectal cancer patients. Methods Clinicopathologic data were prospectively collected on nine patients who underwent robotic total mesorectal excision using four robotic arms for the treatment of mid or low rectal cancer between November 2006 and Febuary 2007. Patient demographics, perioperative clinical outcomes, and pathology results with macroscopic grading (complete, nearly complete, incomplete) were evaluated. Results nine patients with mid or low rectal cancer underwent robotic total mesorectal excison using four robotic arms without serious complications. The mean length of hospital stay was 7.4 ± 1.3 days (range 5.0–10.0 days) and the mean operating time was 220.8 ± 49.4 min (range 153–315 min). Macroscopic grading of the specimen was complete in eight patients and nearly complete in one patient. There were no cases of conversion. Conclusion In the present study, we accomplished nine robot-assisted rectal resections safely and effectively.     

腹腔镜辅助经肛门全直肠系膜切除术与全直肠系膜切除术的临床对比研究

目的对比腹腔镜辅助经肛门全直肠系膜切除术(TaTME)与全直肠系膜切除术(TME)在低位直肠癌中的临床疗效。 方法回顾性分析2014年5月至2016年11月接受TME的83例低位直肠癌患者资料,其中TaTME组41例,TME组42例;采用SPSS 21.0统计学软件进行分析,胃肠指标、肛门功能评分等采用( ±s)表示,独立t检验;并发症等计数资料行χ²或秩和检验;采用Kaplan－Meier法进行生存分析,行log－rank检验;P<0.05为检验水准。 结果TaTME组手术时间、出血量多于TME组,术后恢复指标优于TME组(P<0.05)。TaTME组并发症总发生率7.3%小于TME组19.0%(P<0.05)。术后1个月,两组血清胃动素、胃泌素水平均不同程度降低,TaTME组优于TME组(P<0.05)。术后6个月,TaTME组肛门失禁Wexner评分明显低于TME组(P<0.05);术后12个月时两组评分无差异(P>0.05)。术后6个月时两组肛门功能Kirwan分级比较,TaTME组肛门功能良好率优于TME组(P<0.05)。Kaplan－Meier法生存分析发现,术后2年两组局部复发率、远处转移率及生存率差异无统计学意义(P>0.05)。 结论腹腔镜辅助TaTME治疗低位直肠癌术中安全、可行,其整体疗效优于TME,可在临床治疗中推广使用。     

Initial experience of Chinese surgical robot “Micro Hand S″-assisted versus open and laparoscopic total mesorectal excision for rectal cancer: Short-term outcomes in a single center

BackgroundA Chinese surgical robot, Micro Hand S, was introduced for clinical use as a novel robotic platform. This study aimed to comprehensively compare the early experience of the Micro Hand S robot-assisted total mesorectal excision (TME) with conventional approaches.MethodsBetween May 2017 and April 2018, 99 consecutive patients who underwent open, laparoscopic and Micro Hand S robot-assisted TME (O-/L-/RTME) for rectal cancer were included. Clinical and pathological outcomes were retrospectively analyzed. Surgical success as the primary endpoint was defined as the absence of (i) conversion, (ii) incomplete TME, (iii) involved circumferential and distal resection margins (CRM/DRM), (iv) severe complications.ResultsThe rate of surgical success was similar (89.7 vs. 86.4 vs. 84.6%, p = 0.851) in the three groups and the respective incidences were as follows: conversion (not applicable, 4.5 vs. 2.3%, p = 1.000), incomplete TME (6.9 vs. 6.8 vs. 3.8%, p = 0.980), involved CRM/DRM (0 vs. 2.3 vs. 3.8%, p = 0.592), severe complications (3.4 vs. 4.5 vs. 7.7%, p = 0.844). Compared with open and laparoscopic surgery, the robotic surgery was associated with longer operative time, less blood loss, earlier first flatus time and liquid intake time, and shorter length of hospital stay (p < 0.05).ConclusionsThe Micro Hand S assisted TME is safe and feasible, showing comparable outcomes than conventional approaches, with superiority in blood loss, recovery of bowel function, length of hospital stay, but with increased operative time.     

腹腔镜辅助经肛全直肠系膜切除术后患者排便及排尿功能的影响因素分析

目的:分析低位直肠癌患者腹腔镜辅助经肛全直肠系膜切除术(TaTME)后排便及排尿功能的影响因素.方法:回顾分析2016年10月至2017年10月为85例低位直肠癌患者行腹腔镜TaTME的临床资料.患者35～80岁,平均(60.3±11.4)岁;男43例,女42例,观察患者手术及术后情况、随访结果,术后1年采用低位前切除...     

Robotic total mesorectal excision for the treatment of rectal cancer

Robotic techniques have been developed to facilitate endoscopic surgery and to overcome its disadvantages. Thus, we performed robotic total mesorectal excison (TME) in a patient with rectal cancer, using the da Vinci^® Surgical System. To our knowledge, this is the first robotic low anterior resection, based on standard TME principles, with pelvic autonomic nerve preservation. In conclusion, this robotic system is an excellent instrument for performing the standard TME procedure in rectal cancer patients.     

Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer

Background  Bladder and sexual dysfunction are well-documented complications of rectal cancer surgery. This study aimed to determine whether laparoscopy can improve the outcome of these dysfunctions or not. Methods  The study included 63 of the 116 patients who underwent surgery for rectal cancer between 2002 and 2006. Bladder and male sexual function were studied by means of a questionnaire on the basis of the International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF). In addition, bladder function was determined by means of postvoid residual urine measurement and uroflowmetry. Postoperative functions were compared with the preoperative data to detect subjective functional deterioration. Outcomes were compared between patients who underwent open (group 1, n = 29) and laparoscopic (group 2, n = 34) total mesorectal excision. Results  Only minor disturbances of bladder function were reported for one patient (3%) in group 1 and three patients (9%) in group 2 (p > 0.05). Impotency after surgery was experienced by 6 of 17 preoperatively sexually active males (29%) in group 1 and 1 of 18 males (5%) in group 2 (p = 0.04). Similarly, 5 of 10 women (50 %) in group 1 and 1 of 14 women (7%) in group 2 felt that their overall level of sexual function had decreased as a result of surgery (p = 0.03). Conclusions  Open rectal cancer resection is associated with a higher rate of sexual dysfunction, but not bladder dysfunction, compared with laparoscopic surgery. Laparoscopic rectal cancer surgery offers a significant advantage with regard to preservation of postoperative sexual function and constitutes a true advance in rectal cancer surgery compared with the open technique. The proposed advantages can be attributed to improvement in visibility by the magnification feature of laparoscopic surgery. Presented orally at the 8th National Endoscopic Laparoscopic Surgery Congress, Antalya, Turkey, 1–4 July 2007.     

Implementing new surgical technology: a national perspective on case volume requirement for proficiency in transanal total mesorectal excision

BackgroundEarly data suggest that transanal total mesorectal excision (TaTME) is a safe alternative to the abdominal approach for rectal cancer. This study aims to understand the approach to the management of rectal cancer in Canada and to ascertain perspectives on introducing TaTME.MethodsSurgeons were invited to complete a survey that asked about their management practices relating to rectal cancer and their opinions regarding TaTME.ResultsNinety-four surgeons completed the survey (38% response rate). The number of rectal cancer cases handled annually by surgeons varied widely (1–80 cases, median 15 cases). Twenty-seven percent of respondents performed TaTME at the time of the survey, and 43% of those who did not said they planned on learning the technique. Surgeons who performed TaTME felt that a higher annual volume of rectal cancer cases was required to maintain proficiency than did non-TaTME surgeons (median 20 cases [interquartile range (IQR) 15–25 cases] v. 15 cases [IQR 10–20 cases]). Surgeons who performed TaTME also felt that a higher annual volume of TaTME cases was required to maintain proficiency (median 12 cases [IQR 10–19 cases] v. 9 cases [IQR 5–10 cases]).ConclusionThese findings help define the current practice environment for rectal cancer surgeons in Canada and highlight the complex issues associated with learning TaTME.     

Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis

Background

Robotic surgery has been used successfully in many branches of surgery; but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic total mesorectal excision (RTME) versus laparoscopic total mesorectal excision (LTME) to evaluate whether the safety and efficacy of RTME in patients with RC are equivalent to those of LTME.

Materials and methods

Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated.

Results

Eight studies were identified that included 1229 patients in total, 554 (45.08%) in the RTME and 675 (54.92%) in the LTME. Meta-analysis suggested that the conversion rate to open surgery in RTME was significantly lower than in LTME (P = 0.0004). There were no significant differences in operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, and the oncological accuracy of resection and local recurrence between the two groups. The positive rate of circumferential resection margins (P = 0.04) and the incidence of erectile dysfunction (P = 0.002) were lower in RTME compared with LTME.

Conclusions

RTME for RC is safe and feasible, and the short- and medium-term oncological and functional outcomes are equivalent or preferable to LTME. It may be an alternative treatment for RC. More multicenter randomized controlled trials investigating the long-term oncological and functional outcomes are required to determine the advantages of RTME over LTME in RC.