Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer

Abstract

Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. This study aimed to compare the short-term operative as well as oncologic outcomes of laparoscopic and robotic rectal resection. This study was based on a prospectively collected database of patients with mid- to distal rectal cancer (up to 12cm from the anal verge) undergoing either laparoscopic or robotic low anterior resection from January 2008 to June 2015. Data on patient demographics, intraoperative parameters and short-term outcomes were analyzed. Patient survival and recurrence were also compared. During the study period, 171 and 220 consecutive patients underwent laparoscopic and robotic rectal resection, respectively. The median age was 65years (range 23-96). The median tumor distance was 8 and 7cm from the anal verge in the laparoscopic and robotic groups, respectively (p=0.06). Significantly more male patients and more patients with comorbidities and preoperative radiation underwent robotic surgery. The median operating time for robotic resection was significantly longer, 260 versus 225min (p<0.001). Conversion rates of laparoscopic and robotic resection were 3.5 and 0.8%, respectively (p=0.308). The median hospital stay was 6days in both groups (p=0.29). There was no difference in the overall complication rate, but the incidence of urinary retention was significantly less in the robotic group (4.1 vs. 10.5%, p=0.024). With a median follow-up of 31months, there was no difference in local recurrence, overall survival and disease-specific survival between the two groups. In the treatment of mid- to low rectal cancer, robotic resection can achieve operative results and oncologic outcomes comparable to laparoscopic resection. The postoperative urinary retention rate is lower following robotic surgery.