Short-term outcomes in robotic-assisted versus conventional laparoscopic surgery for rectal cancer: population-based...

This retrospective cohort study compared short-term outcomes between robotic-assisted and conventional laparoscopic surgery for rectal cancer using data from the Swedish Colorectal Cancer Registry.

All patients undergoing elective minimally invasive surgery for rectal cancer between 2014 and 2021 and registered in the Swedish Colorectal Cancer Registry were assessed for eligibility, with patients who underwent robotic-assisted and laparoscopic rectal cancer resection included in the study. The primary outcome was a positive circumferential resection margin (CRM+). Secondary outcomes included conversion to open surgery, total mesorectal excision (TME) specimen quality, and 30-day overall and surgical complications. Multivariable logistic regression analyses were performed.

Of 12 703 patients registered during the study period, 10 914 underwent abdominal resection; of these, 5874 were analysed in this study (3578 robotic-assisted; 2296 conventional laparoscopic surgery). There was no difference in CRM+ between the robotic-assisted and conventional laparoscopic surgery groups (6.5% versus 5.9%, respectively; P = 0.291). Conversion to open surgery was more frequent in the conventional laparoscopic surgery group (16.1% versus 9.1%; P < 0.001). In addition, 30-day surgical complications were more common in the robotic-assisted laparoscopic surgery group (21.5% versus 19.3%; P = 0.044), including a higher rate of anastomotic leakage (10.9% versus 7.4%; P = 0.001). In multivariable analysis, neither technique was an independent predictor of CRM+ (odds ratio (OR) 0.99; 95% confidence interval (c.i.) 0.75 to 1.30; P = 0.925). For secondary outcomes robotic-assisted laparoscopic surgery reduced the risk of conversion to open surgery (OR 0.51; 95% c.i. 0.41 to 0.63; P < 0.001), but resulted in fewer complete TME specimens (OR 0.66; 95% c.i. 0.52 to 0.83; P < 0.001).

No short-term oncological advantage in terms of radial margin positivity was demonstrated between the two techniques. Findings regarding conversion rates, TME specimen quality, and anastomotic leakage warrant further investigation.