MRI 在直肠癌治疗中的常规使用允许对低位直肠癌使用严格的定义。本研究旨在比较专家腹腔镜、经肛门和机器人大容量中心对 MRI 定义的低位直肠癌进行的微创全直肠系膜切除术。纳入了 2015 年至 2017 年间在 11 个荷兰中心进行的所有 MRI 定义的低位直肠癌手术。主要结局为：R1 率、直肠系膜总切除质量以及 3 年局部复发率和生存率（总体和无病生存率）。次要结局包括转化率、并发症以及术前治疗计划是否有围手术期变化。 在 1071 例符合条件的直肠癌中，确定了 633 例低位直肠癌患者。全直肠系膜切除标本的质量（P = 0.337）、R1率（P = 0.107）、转化率（P = 0.344）、吻合口漏率（P = 0.942）、局部复发率（P = 0.809）、总生存率（P =各中心之间的无病生存率（P = 0.436）和无病生存率（P = 0.347）具有可比性。腹腔镜中心组术前治疗计划围术期变更率最高（10.4%），与机器人专家中心（5.2%）和经肛门中心（2.1%）相比，P = 0.004。这种变化的主要原因是吻合困难（43%），其次是肿瘤位置低（29%）。多变量分析表明，腹腔镜手术是改变术前计划手术的唯一独立危险因素，P = 0.024。在所有三种微创全直肠系膜切除技术方面拥有专业知识的中心可以在治疗 MRI 定义的低位直肠癌时实现良好的肿瘤切除。直肠癌。然而，与机器人专家中心和经肛门中心相比，在腹腔镜中心接受治疗的患者由于技术限制而改变术前预期程序的风险增加。© 作者 2024。由牛津大学出版社代表 BJS 出版基金会有限公司

The routine use of MRI in rectal cancer treatment allows the use of a strict definition for low rectal cancer. This study aimed to compare minimally invasive total mesorectal excision in MRI-defined low rectal cancer in expert laparoscopic, transanal and robotic high-volume centres.All MRI-defined low rectal cancer operated on between 2015 and 2017 in 11 Dutch centres were included. Primary outcomes were: R1 rate, total mesorectal excision quality and 3-year local recurrence and survivals (overall and disease free). Secondary outcomes included conversion rate, complications and whether there was a perioperative change in the preoperative treatment plan.Of 1071 eligible rectal cancers, 633 patients with low rectal cancer were identified. Quality of the total mesorectal excision specimen (P = 0.337), R1 rate (P = 0.107), conversion (P = 0.344), anastomotic leakage rate (P = 0.942), local recurrence (P = 0.809), overall survival (P = 0.436) and disease-free survival (P = 0.347) were comparable among the centres. The laparoscopic centre group had the highest rate of perioperative change in the preoperative treatment plan (10.4%), compared with robotic expert centres (5.2%) and transanal centres (2.1%), P = 0.004. The main reason for this change was stapling difficulty (43%), followed by low tumour location (29%). Multivariable analysis showed that laparoscopic surgery was the only independent risk factor for a change in the preoperative planned procedure, P = 0.024.Centres with expertise in all three minimally invasive total mesorectal excision techniques can achieve good oncological resection in the treatment of MRI-defined low rectal cancer. However, compared with robotic expert centres and transanal centres, patients treated in laparoscopic centres have an increased risk of a change in the preoperative intended procedure due to technical limitations.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.