Total mesorectal excision for rectal cancer – laparoscopic versus robotic approach

Abstract

Introduction: The primary goal of this study was to evaluate peroperative and early postoperative results of laparoscopic and robotic surgery for rectal cancer with total mesorectal excision (TME) and with primary anastomosis. Methods: 404 patients were enrolled in the study, divided in two cohorts and compared retrospectively: a laparoscopic group (n=236) versus a robotic (TME + primary coloanal anastomosis) group (n=168). The evaluated cohorts were comparable in sex, age, BMI, ASA score, distal tumor margin from anal verge and neoadjuvant chemoradiotherapy. More advanced tumor stages were observed in the robotic group (p=0.009). Results: The duration of robotic resection was significantly longer compared to laparoscopic resection (p<0.001). Peroperative blood loss (p=0.036), as well as the overall length of hospital stay were significantly lower in the robotic group (p=0.008). No differences were observed in terms of reoperations and intraoperative and postoperative complications. The number of lymph nodes in the histological specimen was higher in the laparoscopic group (p=0.703). Incomplete TME was observed in 4% of laparoscopically operated patients and no patients of the robotic group (p=0.092). Conclusion: Robotic resection of rectal cancer is a promising technique that can help reach better overall quality of surgical intervention in a wider group of patients at departments with sufficiently experienced surgeons and a large volume of thus treated patients.