Robotic surgery for locally advanced rectal cancer: A decade of outcomes from a tertiary referral centre

Robotic surgery offers potential advantages for the surgical management of rectal cancer; however, robust data on its use in locally advanced rectal cancer (LARC) populations are limited. We aimed to evaluate the long-term oncological and perioperative outcomes of robotic surgery in a cohort of patients treated at a single tertiary referral cancer centre.

In this retrospective study, 105 consecutive patients who underwent robotic surgery for rectal adenocarcinoma between July 2012 and May 2024 at a specialist UK centre were analysed. Patient demographics, tumour characteristics, perioperative outcomes (margin status, complications and conversion rate) and survival (disease-free survival [DFS] and overall survival [OS]) were assessed.

The cohort was predominantly male (68.6%) with a median age of 63 (interquartile range 56-70) years. 89.5% of patients had LARC with 53.3% low rectal tumours and 13.3% requiring pelvic exenteration. Neoadjuvant therapy was used in 88.6%. An R0 resection was achieved in 86.7%. The conversion rate to open surgery was low at 0.9%. Clavien-Dindo Grade ≥ III complications occurred in 13.3%, with no 90-day mortality. After a mean follow-up of 53.7 months, the 5-year OS and DFS were 76% and 65%, respectively.

Robotic surgery for LARC in a specialised referral setting is safe and feasible, achieving very low conversion rates and zero perioperative mortality. While the R1 and complication rate reflects the cohort's complexity, it is comparable to benchmarks for advanced pelvic malignancies. These findings endorse the robotic platform for treating challenging rectal cancers within a dedicated multidisciplinary framework.