The rectum is where around 40% of instances of colorectal cancer first appear. However, there are still issues with traditional laparoscopic surgery when it comes to treating rectal cancer. This study evaluated the short- and long-term results of patients with rectal cancer who receive neo-adjuvant treatment and undergo robotic surgery as opposed to laparoscopic surgery.
The study included consecutive individuals who had robotic and laparoscopic rectal resections at a large public medical facility between January 2017 and December 2021. Prior to surgery, all subjects had neo-adjuvant chemoradiotherapy (nCRT). The main goal of this study was to use propensity score matching (PSM) analysis to evaluate the rates of sphincter preservation and conversion to open surgery. Low anterior resection syndrome (LARS), short-term postoperative sequelae, long-term oncological prognosis, and 5-year disease-free survival (DFS) and overall survival (OS) were secondary objectives.
The cohort research included a total of 575 patients with rectal cancer, 183 of whom had robotic surgery and 392 of whom underwent laparoscopic surgery. The robotic group's patients were often younger, had lower tumor sites, greater rates of extramural vascular invasion (EMVI) and circumferential resection margin (CRM) positive, and higher ypT, cT, and cN stages. In the robotic group, PSM produced 183 patients, whereas in the laparoscopic group, it produced 187.
With no discernible difference in conversion to open surgery, this research discovered that the robotic group had a greater sphincter preservation rate than the laparoscopic group. Postoperative chylous ascites was more common in the robotic group, and sepsis could have been less common. 5-year survival rates and long-term oncological prognosis did not differ significantly (P > 0.05).
Each group's median survival period was 34 months. According to a subgroup study of 76 patients with rectal cancer who received intersphincteric resection (ISR) surgery, the cN and cT stages were higher for those who chose robotic surgery. Also, there were no statistically significant differences between the 2 surgical methods in terms of OS time, DFS time, LARS, or short- and long-term clinical outcomes.
There were no appreciable variations in the main outcomes of interest, namely the rates of sphincter preservation and conversion to open laparotomy. Overall, robotic surgery for rectal cancer shows oncological results and technical safety that are equivalent to laparoscopic surgery following preoperative nCRT.
Source:
Zhu, H., Zou, J., Pan, H., Huang, Y., & Chi, P. (2025). Comparison of laparoscopic versus robot-assisted sugery for rectal cancer after neo-adjuvant therapy: a large volume single center experience. BMC Surgery, 25(1), 98. https://doi.org/10.1186/s12893-025-02764-5
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