Robotic vs laparoscopic rectal surgery in high-risk patients

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Laparoscopic rectal surgery presents challenges including a steep learning curve and high conversion rates.
• Robotic systems offer advantages like stable 3D visualization, enhanced dexterity, and improved ergonomics, potentially benefiting complex rectal procedures.

Purpose of the Study:

• To compare the perioperative outcomes of robotic versus laparoscopic rectal cancer surgery.
• To evaluate the efficacy of robotic-assisted surgery in a high-risk patient cohort.

Main Methods:

• Analysis of a prospectively collected dataset of high-risk patients undergoing rectal cancer surgery (May 2013 - November 2015).
• High-risk criteria included BMI ≥30, male gender, preoperative chemoradiotherapy, tumor <8 cm from anal verge, and prior abdominal surgery.

Main Results:

• Robotic surgery (99 patients) showed significantly higher sphincter preservation (86% vs 74%), shorter operative time (240 vs 270 min), and reduced hospital stay (7 vs 9 days) compared to laparoscopy (85 patients).
• Robotic approach resulted in less blood loss (10 vs 100 ml) and a lower conversion rate to open surgery (0% vs 5%).
• Reoperation, anastomotic leak, 30-day mortality, and oncological outcomes were comparable between groups.

Conclusions:

• Robotic rectal cancer surgery in high-risk patients is associated with improved perioperative outcomes, including better sphincter preservation and reduced complications.
• Further research is warranted to validate these findings and assess long-term oncological control.