Innovative Approaches in Colorectal Cancer Surgery: Evaluation and Economic Implications
Robotic beyond TME was associated with higher overall morbidity than standard TME in a retrospective multicenter cohort (n=462), driven primarily by urinary dysfunction; rates of severe complications and conversion were similar.
The retrospective multicenter study (n=462; 391 R-sTME, 71 R-bTME) reported comparable conversion rates and no major differences in operative time, blood loss, or length of stay. However, the rate of positive radial margin was higher in the R-bTME group (8.5% vs 1.0%).
Together, these data suggest that R-bTME and R-sTME share similar conversion and severe-complication profiles, but R-bTME may carry higher risk of positive radial margins and urinary dysfunction; careful preoperative staging and patient selection are therefore warranted.
Evidence on LDH as a prognostic stratifier in CEA/CA19-9–negative patients remains preliminary and hypothesis-generating; LDH should not be used for routine prognostic stratification pending larger, adjusted cohort studies reporting effect estimates.
Economic comparisons are context-dependent. When available, report ICERs or cost-per-QALY estimates and clarify major cost drivers and assumptions, which can influence choice and timing of neoadjuvant strategies in multidisciplinary planning.
Key Takeaways:
- Higher overall morbidity—largely urinary dysfunction—despite similar severe-complication and conversion rates; this affects surgical selection and preoperative counseling and supports targeted selection and focused consent protocols.
- The higher positive radial-margin signal with R-bTME is most relevant for locally advanced disease and supports stricter staging and multidisciplinary selection pathways to optimize margin status.
- LDH may stratify CEA/CA19‑9–negative patients but requires prospective validation. Major cost drivers make FOLFOX versus long-course chemoradiotherapy context-dependent—use institution-level cost modeling to inform neoadjuvant planning.