全直肠系膜切除术（TME）是低/中局部晚期直肠癌的标准手术。本研究的目的是比较三种初次吻合 TME 的微创手术方法（腹腔镜 TME、机器人 TME 和经肛门 TME）。 根据标准化，2013 年至 2022 年接受腹腔镜 TME、机器人 TME 或经肛门 TME 的患者记录对欧洲 MRI 和直肠癌手术 III (EuMaRCS-III) 数据库贡献的专家中心的技术进行了分析。采用倾向评分匹配法比较三组的并发症发生率（主要结局）、转化率、术后恢复情况和生存率。共纳入468例患者（平均（s.d.）年龄64.1（11）岁） ; 190 名患者（40.6%）接受了腹腔镜 TME，141 名患者（30.1%）接受了机器人 TME，137 名患者（29.3%）接受了经肛门 TME。倾向评分匹配后的比较分析表明，与机器人 TME（OR 1.80，95% c.i. 1.11-2.91）和经肛门 TME（OR 2.87，95% c.i. 1.72-4.80）相比，腹腔镜 TME 术后并发症发生率更高。与腹腔镜 TME (8.8%) 和经肛门 TME (8.1%) 相比，机器人 TME 与较低的 A 级吻合口漏发生率 (2%) 相关 (P = 0.031)。与腹腔镜 TME (8.8%) 相比，机器人 TME (1.4%) 和经肛门 TME (0.7%) 均与较低的开放手术转化率相关 (P < 0.001)。接受经肛门 TME 治疗的患者排气时间和住院时间较短（分别为 P = 0.003 和 0.001）。手术时间、术中并发症、失血量、死亡率、再入院、R0 切除或生存率没有差异。在这项针对局部晚期直肠癌患者的多中心、回顾性、倾向评分匹配队列研究中，采用了较新的微创方法（与腹腔镜 TME 相比，机器人 TME 和经肛门 TME）显示出更好的结果。© 作者 2024。由牛津大学出版社代表 BJS Foundation Ltd 出版。

Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME).Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival.A total of 468 patients (mean(s.d.) age of 64.1(11) years) were included; 190 (40.6%) patients underwent laparoscopic TME, 141 (30.1%) patients underwent robotic TME, and 137 (29.3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1.80, 95% c.i. 1.11-2.91) and transanal TME (OR 2.87, 95% c.i. 1.72-4.80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8.8%) and transanal TME (8.1%) (P = 0.031). Robotic TME (1.4%) and transanal TME (0.7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8.8%) (P < 0.001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0.003 and 0.001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival.In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.