The Impact of Robotic Surgery for Mid and Low Rectal Cancer A Case-Matched Analysis of a 3-Arm Comparison-Open, Laparoscopic, and Robotic Surgery

Objective: The objective of this study was to clarify the impact of robotic surgery (RS) in the management of mid and low rectal cancer in comparison with open surgery (OS) and laparoscopic surgery (LS). Background: The benefits of RS in the treatment of rectal cancer have not yet been clearly described. Methods: Using propensity scores for adjustment of sex, age, body mass index, tumor stage, and tumor height, a well-balanced cohort with 165 patients in each group, was created by matching each patient who underwent RS as the study group with one who underwent OS or LS as the control group (RS: OS = 1: 1, RS: LS = 1: 1 match). Pathological results, morbidity, perioperative recovery, and short-term oncological results were compared between the 3 groups. Results: In RS and LS, the time to first flatus and resumed soft diet and length of hospital stay were significantly shortened compared with OS. Robotic surgery showed better recovery outcomes than LS with regard to time to resumed soft diet and length of hospital stay. The visual analog scale was significantly lower in the RS than in the OS and LS from postoperative days 1 to 5. The voiding problem and circumferential resection margin involvement rate were significantly lower in the RS group than in the OS group. No significant difference in 2-year disease-free survival was observed among the 3 groups. Conclusions: Robotic surgery may be an effective tool in the effort to maximize the advantages of minimally invasive surgery in the management of mid to low rectal cancer.