Robotic-assisted versus laparoscopic surgery for low rectal cancer: Case-matched analysis of short-term outcomes

Purpose: The aim of this study is to compare short-term outcomes and surgical quality of robot-assisted (RAP) and laparoscopic (LAP) total mesorectal excision (TME) in patients with low rectal cancer. Methods: From December 2007 to June 2009, 41 consecutive patients with low rectal cancer underwent TME by robot-assisted procedures. The lowest tumor margins were below peritoneal reflection and 1.0-8.0 cm above the anal verge. These patients were matched 1:2 by age, gender, body mass index, date of surgery, American Society of Anesthesiologists score, and tumor stage, with 82 patients who underwent conventional LAP. Macroscopic quality of the specimens and operative and postoperative outcomes were compared. Results: Mean operation time was 168.0 ± 49.3 min for LAP group and 231.9 ± 61.4 min for RAP group (P < 0.001). Time to regular diet (RAP, 6.7 days vs. LAP, 6.6 days) and length of stay (RAP, 9.9 days vs. LAP, 9.4 days) were similar. The proportion of surgeries performed with the modified natural orifice techniques (totally intracorporeal procedures with transanal or transvaginal retrieval of specimens) was significantly higher in the RAP group (RAP, 48.8% vs. LAP, 13.4%; P < 0.001). There were no between-group differences in specimen quality, including distal resection margins, harvested lymph nodes, and circumferential margins. The overall major complication rates were similar (RAP, 9.8% vs. LAP, 7.3%; P = 0.641). Conclusions: RAP was safe and effective for patients with low rectal cancer. Furthermore, the technical advantages of robot surgical systems may allow a novel approach using hybrid natural orifice surgery.