Evaluating the effectiveness and safety of robotic versus laparoscopic resections for patients with low rectal cancer.

This study evaluated the effectiveness and safety of robotic versus laparoscopic abdominoperineal resections (APRs) for the treatment of patients with low rectal cancer (RC). The data showed that robotic APRs significantly reduced surgical trauma and promoted recovery after surgery compared with laparoscopic APRs in these patients.

Rectal cancer (RC) is one of the most common types of cancer worldwide. RC involves the final part of the large intestine or rectum. A low rectal cancer is one that is close to the anus. Low RC can be treated by surgical removal of the tumor. The standard type of surgery, abdominoperineal resection (APRs), involves the removal of the anus, rectum, and part of the colon.

There are different types of surgery to remove the rectal tumor. In a minimally invasive surgery (MIS), doctors use small incisions (cuts) and few stitches to operate with less damage to the body than with open surgery. Laparoscopic surgery (LS) involves a surgeon manually removing the tumor using a camera to guide them through small incisions. Robotic surgery (RS) involves the surgeon using a computer to move the surgical tools to remove the tumor. In RS, the surgeon has a better range of motion with the tools and can get more accurate images with the camera. However, the effectiveness and safety of robotic versus laparoscopic APRs for the treatment of patients with low RC are still unknown.

This study involved 347 patients with low RC. 174 patients were treated with robotic APRs. 173 patients were treated with laparoscopic APRs. Patients were followed up for an average of 49 months. 

The rate of complications after surgery was significantly lower in group 1 (13.2%) than in group 2 (23.7%). The rate of conversion to open surgery (a larger incision in the abdomen to remove the tumor) was significantly lower in group 1 (0%) than in group 2 (2.9%). The amount of blood loss during surgery was significantly lower in group 1 (100 mL) than in group 2 (130 mL).

The rate of readmission to the hospital was significantly lower in group 1 (2.3%) than in group 2 (6.9%). The average number of days for hospital stay after surgery was significantly shorter for group 1 (5 days) than in group 2 (7 days).

Urinary and sexual function was improved in group 1 compared to group 2.

No significant difference was observed in the long-term oncological outcomes between the two groups. The 3-year survival without signs of cancer was 85.3% in group 1 compared to 84.6% in group 2. After 3 years, 91.1% of patients in group 1 were alive compared to 90.4% in group 2. 

This study concluded that robotic APRs significantly reduced surgical trauma and promoted recovery after surgery compared with laparoscopic APRs in patients with low RC, with similar oncological outcomes.

This study only included patients treated at a single institution in China. Only 2 surgeons performed the operations. The patients knew which type of surgery they were getting. This might affect the conclusions.