The safety of robot-assisted surgery versus laparoscopic surgery for rectal tumor patients.

Abstract

56 Background: Robotic assisted surgery for the rectum has dramatic increased. In addition to the magnifying effect of laparoscopic benefit, robot-assisted surgery has multi-joint function and 3D vision which allows more precise manipulation in the deep pelvic region and is thought to contribute significantly to perioperative safety. However, the superiority of robotic-assisted surgery still remains controversial. In this study, we compared the short-term results of laparoscopic and robotic-assisted surgery for rectal tumors. Methods: This study was a single-center, retrospective study. We included 273 rectal tumor patients who underwent surgery with anastomosis from 2017 to 2021. 169 patients underwent laparoscopic surgery (Lap group) and 104 patients underwent robotic-assisted surgery (Robot group). Postoperative complications were compared by matching using the propensity score based on the IPTW method with the maximum tumor diameter, cT, and cN stage as adjustment factors (SMD≤0.2 was defined as no difference between the groups). Results: Among the patient backgrounds, blood loss, LPLN dissection and tumor diameter showed significant difference. Moreover, rate of cT3-4, cN positive were significantly high in the Lap group. The rate of postoperative complications based on clavien-dindo classification (Lap group vs Robot group), grade II or higher in 29.6% vs 19.2%, grade III or higher in 11.2% vs 5.8% and anastomotic leakage (all grade) in 5.9% vs 4.8%. Adjusted by propensity score matching for all the factors of SMD≤0.2, though there was no significant difference in anastomotic leakage (OR 0.76, 95%CI 0.46-1.27, p=0.296), both postoperative complications of grade II or higher (OR 0.66, 95%CI 0.50-0.87, p=0.004) and grade III or higher (OR 0.29, 95%CI 0.16-0.53, p<0.001) were significantly lower in the Robot group. Conclusions: The results of this study showed better short-term outcomes which suggest that robotic-assisted surgery for rectal tumor is superior in safety than laparoscopic surgery.