Ten years of robot-assisted versus laparoscopic total mesorectal excision for rectal cancer (short-term RESOLUTION)

Background: Total mesorectal excision is the gold standard for rectal cancer surgery, with laparoscopic and robot-assisted approaches commonly employed. While robot-assisted surgery may offer technical advantages, there is limited evidence comparing short-term outcomes of laparoscopic and robot-assisted techniques, particularly in Western European populations. This study aimed to assess the short-term outcomes of laparoscopic versus robot-assisted total mesorectal excision for rectal cancer.

Methods: This multicentre, international, retrospective cohort study included 1749 patients who underwent laparoscopic or robot-assisted total mesorectal excision from January 2014 to January 2024. Inverse probability of treatment weighting was applied to minimise confounding. Primary outcomes were length of stay, operative time, and conversion rates. Secondary outcomes included complications and pathological outcomes within 90 days, and readmissions and reinterventions within 30 days.

Results: The final cohort included 680.9 laparoscopic and 1057.5 robot-assisted cases after weighting. Robot-assisted surgery showed lower conversion rates (6.1% vs. 3.5%, p=0.025), higher rates of primary anastomosis (80.1% vs. 92.1%, p<0.001), and fewer stoma formations (78.4% vs. 63.7%, p<0.001). Pathological outcomes indicated a higher rate of complete mesorectal excision in the robot-assisted group (77.2% vs. 86.0%, p<0.001), though this data was not available for all centres. Operative time was longer in the robot-assisted cohort (181.0 vs. 220.0 minutes, p<0.001), but no significant differences were observed in postoperative complications, length of stay, anastomotic leakage or 30-day reintervention rates.

Conclusion: Robot-assisted surgery low anterior resection demonstrated improved short-term outcomes with lower conversion rates, higher rates of complete mesorectal excision, and higher restorative procedure rates, which may influence longer-term oncological and patient quality of life outcomes.