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Robotic versus laparoscopic rectal cancer surgery during institutional transition: a 10-year sequential cohort study
Zsolt Madarasz1, Krzysztof Nowakowski1, Michael Leitz1
1Department of Surgery, Bielefeld University, Medical School and University Medical School Ostwestfalen-Lippe (OWL) - Campus Hospital Lippe, Detmold, Germany.
Frontiers in Oncology
|August 14, 2026
Summary
Robotic rectal cancer surgery showed fewer conversions and shorter hospital stays compared to laparoscopy. Mid-term oncologic outcomes were similar, suggesting potential perioperative benefits without compromising results.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Rectal Cancer Treatment
Background:
- Debate exists regarding the clinical benefits of robotic versus laparoscopic rectal cancer surgery.
- This study compares perioperative, pathological, and mid-term oncologic outcomes of robotic and laparoscopic rectal cancer resection.
- It analyzes an institutional transition from laparoscopic to robotic surgery.
Purpose of the Study:
- To compare perioperative, pathological, and mid-term oncologic outcomes between robotic and laparoscopic rectal cancer resection.
- To evaluate the impact of transitioning surgical techniques on patient outcomes.
- To assess the safety and efficacy of robotic rectal cancer surgery in a real-world setting.
Main Methods:
- Retrospective, sequential era-based cohort study (2015-2024) of 239 patients with UICC stage I-III rectal adenocarcinoma.
- Laparoscopic surgery was standard until June 2018, followed by robotic surgery implementation (da Vinci X).
- Propensity score overlap weighting was used to adjust for baseline differences; outcomes included conversion rates, mesorectal excision quality, operative time, hospital stay, complications, and survival endpoints.
Main Results:
- Robotic surgery had significantly lower conversion rates (2.7% vs 15.1%) and shorter postoperative stays (mean difference -4.72 days).
- Operative time was longer with robotic surgery (+35.33 min).
- No significant differences were found in mesorectal excision quality, anastomotic leakage, major morbidity, mortality, or mid-term oncologic outcomes (overall survival, disease-free survival, local recurrence, distant metastasis).
Conclusions:
- Robotic rectal cancer surgery demonstrated perioperative advantages, including fewer conversions and shorter hospitalizations, compared to laparoscopy.
- Pathological quality and mid-term oncologic outcomes were not negatively impacted by the robotic approach.
- While suggesting potential benefits, the study was not powered to establish definitive oncologic equivalence.
