METHODS: Adults with cT1-4a Nx M0 rectal adenocarcinoma within 10 cm of the anal verge were randomized 1 : 1 to L-TME or R-TME at three Korean tertiary centres between July 2011 and February 2016. Pre-specified secondary endpoints were 5-year overall, relapse-free, local recurrence-free, and distant recurrence-free survival. Analyses were on a modified intention-to-treat basis.
RESULTS: Of 295 analysed patients (144 L-TME patients and 151 R-TME patients; median follow-up of 72.6 months), 5-year overall survival (92.6% versus 92.4%; P = 0.838) and relapse-free survival (81.9% versus 83.0%; P = 0.801) were similar. Local recurrence occurred in 4.9% (L-TME) and 1.3% (R-TME); 5-year local recurrence-free and distant recurrence-free survival did not differ (P = 0.076 and P = 0.655). In a post-hoc analysis of 146 patients who received neoadjuvant chemoradiotherapy, 5-year local recurrence-free survival was 98.6% in R-TME patients versus 90.7% in L-TME patients (P = 0.039).
CONCLUSION: R-TME and L-TME produced equivalent 5-year oncological outcomes. A post-hoc analysis suggested improved local control with robotic surgery after neoadjuvant chemoradiotherapy, requiring confirmation in prospectively designed studies.
REGISTRATION NUMBER: NCT01423214 (http://www.clinicaltrials.gov).
METHODS: This guideline was jointly developed by the Colorectal Cancer Committee of the China Anti-Cancer Association and the International Alliance of NOSES, incorporating recent multicenter data, consensus discussions, and advancements in laparoscopic and robotic techniques. This updated guideline was developed through an expert consensus-based revision process informed by comprehensive literature review and available multicenter clinical evidence, and was finalized after iterative discussion and approval by the guideline steering committee.
RESULTS: This edition provides targeted updates from the previous version, including refined recommendations on preoperative assessment and acknowledgment of robotic assistance. Adjustments to surgical classifications, indications, and procedural descriptions have also been made to enhance clarity and clinical applicability.
CONCLUSION: This updated guideline provides a structured and practical reference for colorectal NOSES procedures, supporting wider adoption and continued surgical advancement.