Robotic abdominoperineal resection for rectal cancer is associated with reduced conversion risk compared with a...

Evidence on the benefits of robotic vs laparoscopic approaches to abdominoperineal resection for rectal cancer is conflicting. This study aimed to determine whether the robotic approach offers a lower risk of conversion to open surgery and positive radial margins than the laparoscopic approach.

Patients who underwent elective abdominoperineal resection for rectal cancer in the 2016-2022 American College of Surgeons National Surgical Quality Improvement Program proctectomy database were stratified by the laparoscopic vs robotic approach. The primary outcomes were rates of conversion to open surgery and positive radial margins. The secondary outcomes included 30-day readmission and indication. Multivariable regressions were performed to assess outcome associations.

Of 3925 patients, 1973 (50.3%) underwent laparoscopic resection, and 1952 (49.7%) underwent robotic abdominoperineal resection. The proportion of robotic cases increased significantly from 2016 to 2022, surpassing laparoscopic surgery (P <.001). Compared with patients who underwent laparoscopic resection, those who underwent robotic resection had a higher body mass index (≥35 kg/m²; 12.1% vs 15.2%, respectively; P <.001) and more frequent flap reconstruction (7.0% vs 11.1%, respectively; P <.001). On univariate analysis, compared with the laparoscopic approach, the robotic approach was associated with fewer conversions to open surgery (12.0% vs 3.6%, respectively; P <.001) but no difference in rates of positive radial margins (9.3% vs 10.1%, respectively; P =.41). Multivariate analysis demonstrated that the robotic approach was associated with decreased conversion rates (odds ratio [OR], 0.24; P <.001) without compromising radial margins (OR, 1.10; P =.46) but increased 30-day readmissions (OR, 1.23; P =.03), most commonly for wound or organ space infections (OR, 1.44; P =.02).

Robotic abdominoperineal resection is associated with reduced risk of conversion to open surgery without compromising the circumferential resection margin. However, it is associated with increased readmission, particularly for wound and organ space infections.