Advantage of robotic surgery for rectal cancer

Background and aim
Robotic surgery is expected to be effective for rectal cancer; however, its clinical evidence is limited. In this study, we try to elucidate the possible advantage of robotic surgery for rectal cancer.
Patients
Outcomes of 340 rectal cancers treated with robotic (n=173) and laparoscopic (n=167) low anterior resection between 2008 and 2021 were retrospectively analyzed. Preoperative chemoradiotherapy (CRT) was performed for lower advanced cancers (n=119).
Results
Age (63, mean), sex (male, 66%), and clinical stages (stage 0, 1%; stage I, 24%; stage II, 38%; stage III, 28%; stage IV, 4%) were not different between the groups. Lateral pelvic lymph node dissection was performed more frequently (25% vs. 6%, p<0.01), and the number of dissected lymph nodes was tended to be larger in robotic surgery (7.3 vs. 5.4, per side, p=0.06). Among CRT cases, the tumor distance from anal verge was shorter (55mm vs. 64mm, p<0.01), and the distal resection margin was longer (25mm vs. 20mm, p=0.03) in robotic surgery. Surgical site infection (0% vs. 8%, p<0.01), including anastomotic leakage (0% vs. 4%, p<0.01), was not observed in robotic surgery. 5-year overall survival (96% vs. 91%) and local recurrence rates (4% vs. 2%) were not different between the groups.
Conclusions
Our results suggested the technical advantage of robotic surgery for rectal cancer, and the oncological outcomes were good and not different between the two surgical approaches.