Robotic vs laparoscopic resection of rectal cancer: short-term outcomes of a case-control study

Few data are available to compare robotic and laparoscopic techniques for rectal cancer resection. This study aimed to compare short-term outcomes with these procedures performed by a single surgeon.

Using data from a prospective database of all operations performed in our department, we retrospectively analyzed data from 117 robotic and 102 laparoscopic rectal cancer resections performed by one surgeon between July 2007 and October 2009. Robotic resection was offered as a treatment option to all patients, and laparoscopic resection was performed for those who refused. This analysis was a case-control study in which patients in the 2 groups were matched according to tumor location, staging, age, and gender.

A total of 118 patients (59 matched pairs) were included in the study. No differences were found between robotic and laparoscopic resection regarding number of lymph nodes harvested (median, 20; interquartile range, 12-27 vs 21; 14-28; P = .702) or distal resection margin (median, 2.2 cm; interquartile range, 1.5-3.0 cm vs 2.0; 1.2-3.5 cm; P = .865). The circumferential margin was positive (≤ 2 mm) in 1 patient in the robotic group but in none of the laparoscopic group (P > .999). Operating time was longer in the robotic group than in the laparoscopic group (P < .0001). No conversions were necessary in the robotic group, but 2 cases (3.4%) were converted to open surgery in the laparoscopic group (P = .496). No differences were observed between groups regarding postoperative complications. Operative mortality was zero in both groups. During a median follow-up of 15.0 months, 2 cases of distant metastases and 1 case of local recurrence were observed in each group.

Robotic rectal cancer resection can be safely performed by experienced laparoscopic surgeons, with acceptable short-term outcomes comparable to those for laparoscopic resection.