Robotic versus Laparoscopic Intersphincteric Resection for Low Rectal Cancer: Comparison of Short-term Clinical Outcomes

Abstract

Purpose. The intersphincteric resection (ISR) technique has been employed to extend the opportunity for sphincter preservation in patients with low rectal cancer. The aim ofthis study was to compare the short-term outcomes forrobot-assisted and laparoscopic ISR for rectal cancer. Methods. One hundred and six patients with rectalcancer who underwent curative resection between November 2009 and April 2014 were included. Patients were classified into the laparoscopic group (n = 31), and the robotic group (n = 75). Data analyzed include estimated blood loss, operating time, time to first flatus passage, time to normal diet, length of hospital stay, histopathologic status including distal resection margin, status of circumferential resection margin (CRM), and number of lymph nodes harvested. Results. Analyses on clinical results revealed mean estimated blood loss of 110.3 ml (range, 30-300 ml) in the laparoscopic group, and 69.7 ml (range, 30-200 ml) in the robotic group, indicating statistically significant different (p = 0.004). The mean operating time was 382.1 minutes (range, 210-600 minutes) in the laparoscopic group, and 466.2 minutes (range, 285-720 minutes) in the robotic group, also showing statistically significant difference (p ＜ 0.001). In contrast, there were no statistically significant differences in length of postoperative hospital stay, resumption of oral diet, and regaining of bowel peristalsis between these two operative procedures (p = 0.937, 0.149, and 0.071, respectively). Conclusions. The findings showed that robotic ISR, a minimally invasive approach for rectal cancer, has acceptable morbidity and mortality rates as well as reasonable oncological outcomes, but is currently too expensive with longer operating time compared with conventional laparoscopy.