Optimising minimally invasive surgical techniques for rectal cancer treatment.

This prospective observational multicentre cohort study made possible by a public private partnership with Intuitive surgical aims to compare quality of life, functional outcomes, and costs of laparoscopic, robot-assisted, and transanal total mesorectal excision, performed by surgeons in dedicated centres with profound experience with one of the tree minimally invasive techniques.

Total mesorectal excision is the standard of care for rectal cancer, which can be performed using open, laparoscopic, robot-assisted, and transanal technique. Large prospective (randomised controlled) trials comparing these techniques are lacking and focus primarily on short term or long-term oncological without addressing relevant patient outcomes of quality of life, functional outcomes, and cost-effectiveness. Comparative data with regard to these outcomes is necessary to identify the optimal minimally invasive technique.

The VANTAGE trial will be a prospective observational multicentre cohort trial, aiming to compare laparoscopic, robot-assisted, and transanal total mesorectal excision in adult rectal cancer patients performed by experienced surgeons in dedicated centres. Data collection will be performed in collaboration with the prospective Dutch ColoRectal Audit and the Prospective Dutch ColoRectal Cancer Cohort so patients are not burdened by additional questionnaires. Quality of life at 1 year postoperatively will be the primary outcome. Functional outcomes, cost-effectiveness, short term outcomes, and long-term oncological outcomes will be the secondary outcomes. In total, 1200 patients will be enrolled over a period of two years in twenty-six dedicated centres in the Netherlands. Through this data is expected to identify the optimal minimally invasive technique, improve patient outcomes and provide guidelines for clinical application.