Clinical significance of robot-assisted laparoscopic surgery for rectal cancer: a retrospective propensity score matching analysis.

Objective: Conventional laparoscopic surgery (CLS) for rectal cancer may sometimes be difficult. Robot-assisted laparoscopic surgery (RALS) is expected to overcome these technical challenges of CLS and provide better short-term outcomes. However, previous randomized controlled trials indicated that the safety and feasibility of RALS compared to CLS remain controversial; therefore, we assessed the safety and feasibility of RALS for rectal cancer compared with CLS.

Methods: This study retrospectively reviewed 702 patients who had undergone anterior resection by CLS or RALS for rectal malignancies from January 2009 to December 2023. Among the patients, 313 and 75 were included in the CLS and RALS groups, respectively. Short- and midterm outcomes of the two groups were compared after performing propensity score matching analysis (PSM) to adjust for patient and tumor characteristics.

Results: A total of 140 and 70 patients in the CLS and RALS groups, respectively, were matched using PSM. The bleeding amount and C-reactive protein (CRP) levels on postoperative days 1 and 3 were significantly lower, the operation time was longer, and the postoperative hospital stay was significantly shorter in the RALS group than in the CLS group. The Kaplan-Meier curves for cause-specific survival, relapse-free survival, and the cumulative incidence of local recurrence demonstrated no difference between the two groups.

Conclusions: RALS for rectal cancer provided superior outcomes to CLS in terms of the bleeding amount, postoperative CRP levels, and postoperative hospital stay. The midterm oncological outcomes in RALS were comparable to those in CLS.