The Multidisciplinary Approach of Rectal Cancer: The Experience of "COMRE Group" Model

Background: Total mesorectal excision (TME) is the gold standard to treat locally advanced rectal cancer. This monocentric retrospective study evaluates the results of laparotomic, laparoscopic and robotic surgery in "COMRE GROUP" (REctalCOMmittee). Methods: 327 selected stage I-II-III patients (pts) underwent TME between November 2005 and April 2020 for low or middle rectal cancer; 91 pts underwent open, 200 laparoscopic and 36 robotic TME. Of these, we analyzed the anthropomorphic, intraoperative, anatomopathological parameters and outcome during the follow up. Results: The length of hospital stay was significantly different between robotic TME and the other two groups (8.47 +/- 3.54 days robotic vs. 11.93 +/- 5.71 laparotomic, p < 0.001; 8.47 +/- 3.54 robotic vs. 11.10 +/- 7.99 laparoscopic, p < 0.05). The mean number of harvested nodes was higher in the laparotomic group compared to the other two groups (19 +/- 9 laparotomic vs. 15 +/- 8 laparoscopic, p < 0.001; 19 +/- 9 laparotomic vs. 15 +/- 7 robotic, p < 0.05). Median follow-up was 52 months (range: 1-169). Overall survival was significantly shorter in the open TME group compared with the laparoscopic one (Chi2 = 13.36, p < 0.001). Conclusions: In the experience of the "COMRE" group, laparoscopic TME for rectal cancer is a better choice than laparotomy in a multidisciplinary context. Robotic TME has a significant difference in terms of hospital stay compared to the other two groups.