Long-term outcomes of robotic versus laparoscopic total mesorectal excisions: a propensity-score matched cohort study of 5-year survival outcomes

Rauand Duhoky, Marieke Rutgers, Thijs Burghgraef, Samuel Stefan, Shamsul Kabir Masum, Guglielmo Niccolo Piozzi, Filippos Sagias, Jim Khan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Objective: To compare long-term outcomes between laparoscopic and robotic total mesorectal excisions (TMEs) for rectal cancer in a tertiary center.

Background: Laparoscopic rectal cancer surgery has comparable long-term outcomes to the open approach, with several advantages in short-term outcomes. However, it has significant technical limitations, which the robotic approach aims to overcome.

Methods: We included patients undergoing laparoscopic and robotic TME surgery between 2013 and 2021. The groups were compared after propensity-score matching. The primary outcome was 5-year overall survival (OS). Secondary outcomes were local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and short-term surgical and patient-related outcomes.

Results: A total of 594 patients were included, and after propensity-score matching 215 patients remained in each group. There was a significant difference in 5-year OS (72.4% for laparoscopy vs 81.7% for robotic, P = 0.029), but no difference in 5-year LR (4.7% vs 5.2%, P = 0.850), DR (16.9% vs 13.5%, P = 0.390), or DFS (63.9% vs 74.4%, P = 0.086). The robotic group had significantly less conversion (3.7% vs 0.5%, P = 0.046), shorter length of stay [7.0 (6.0–13.0) vs 6.0 (4.0–8.0), P < 0.001), and less postoperative complications (63.5% vs 50.7%, P = 0.010).

Conclusions: This study shows a correlation between higher 5-year OS and comparable long-term oncological outcomes for robotic TME surgery compared to the laparoscopic approach. Furthermore, lower conversion rates, a shorter length of stay, and a less minor postoperative complications were observed. Robotic rectal cancer surgery is a safe and favorable alternative to the traditional approaches.
Original languageEnglish
Article numbere404
Number of pages8
JournalAnnals of Surgery Open
Volume5
Issue number2
Early online date27 Mar 2024
DOIs
Publication statusEarly online - 27 Mar 2024

Keywords

  • laparoscopy
  • long-term outcomes
  • rectal cancer
  • robotic
  • total mesorectal excision

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