全直肠系膜切除术(TME)被接受为直肠癌肿瘤切除的黄金标准。最佳的TME方法正在争议中，通常外科医生会选择一种更受欢迎的方法。本研究旨在描述机器人(R-TME)和经直肠(TaTME) TME如何被整合到高容量直肠癌肿瘤外科医生的实践中，并比较临床、肿瘤学结果和成本分析。本研究采用前瞻性对照队列研究方法，在同一位外科医生进行了50例R-TME和50例TaTME后进行比较。对肿瘤特征进行比较以突出每种技术的特定作用。比较了临床结果(手术持续时间、住院时间和围手术期并发症)、肿瘤质量指标(切除边缘和TME的完整性)和成本分析。统计分析采用IBM SPSS 20版本进行。在中直肠癌中，R-TME优于TaTME，在低位直肠癌中，TaTME更优(9cm vs. 5cm，p<0.001)。R-TME手术持续时间比TaTME长(265分钟vs. 179分钟，p<0.001)。10%的R-TME和14%的TaTME出现了严重并发症(CD III-IV级并发症)(p=0.476)。使用R-TME和TaTME均达到98%(n=49)的清晰R0切除边缘和86%(n=43)的完整的系膜质量定义为“完整”的R-TME及82%(n=41)的TaTME。R-TME的住院时间较短(5天vs. 7天，p=0.624)。整体而言，TaTME更经济，节省了131欧元。在高容量的直肠癌外科手术实践中，可以根据患者和肿瘤特征进行R-TME和TaTME两种方法的操作，其临床和肿瘤学的结果可比，并且具有成本效益。©2023年。作者(们)在Springer-Verlag London Ltd.,亚伯利金集团中，独家许可下发表。

Total mesorectal excision (TME) is accepted as the gold standard for oncological resection in rectal cancer. The best approach to TME is debated and often surgeons will select a preferred approach. In this study, we aimed to describe how both robotic (R-TME) and transanal (TaTME) TME can be integrated into high-volume rectal cancer surgeon practice with a comparison of clinical and oncological outcomes and cost analysis. A prospective comparative cohort study was performed in a high-volume rectal cancer centre comparing the previous 50 R-TME and 50 TaTME performed by the same surgeon. A comparison of tumour characteristics was performed to highlight a specific role for each technique. Clinical outcomes (operative duration, length of stay (LOS) and perioperative morbidity), cancer quality indicators (resection margin and completeness of TME) and cost analysis were compared. Statistical analysis was performed using IBM SPSS, version 20. R-TME was preferred in mid-rectal cancer, compared to TaTME preferred in low rectal cancer (9 cm vs. 5 cm, p < 0.001). Operative duration was longer in R-TME compared to TaTME (265 vs. 179 min, p < 0.001). Major complications (CD III-IV complications) were experienced in 10% of R-TME and 14% of TaTME (p = 0.476). A 98% (n = 49) clear R0 resection margin was achieved with both R-TME and TaTME and mesorectum quality defined as 'complete' in 86% (n = 43) in R-TME and 82% (n = 41) in TaTME. Length of hospital stay was shorter in R-TME (5 vs. 7 days, p = 0.624). An overall difference of €131 was observed favouring TaTME. In high-volume rectal cancer surgery practice, both R-TME and TaTME can be practised and tailored according to patients and tumour characteristics, with comparable clinical and cancer outcomes and is cost-effective.© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.