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Comparative Study
. 2025 Jan;39(1):184-193.
doi: 10.1007/s00464-024-11374-w. Epub 2024 Nov 1.

Short- and long-term outcomes of robotic and laparoscopic surgery in rectal cancer: a propensity score-matched analysis

Yasuyuki Takamizawa  1 , Shunsuke Tsukamoto  2 , Takeharu Kato  2 , Hiroshi Nagata  2 , Konosuke Moritani  2 , Yukihide Kanemitsu  2
Affiliations
Comparative Study

Short- and long-term outcomes of robotic and laparoscopic surgery in rectal cancer: a propensity score-matched analysis

Yasuyuki Takamizawa et al. Surg Endosc. 2025 Jan.

Abstract

Purpose: The relative benefits of robotic surgery and laparoscopic surgery are controversial in rectal cancer. This study compared the short- and long-term outcomes of robotic surgery with those of laparoscopic surgery in patients with rectal cancer using propensity score analysis.

Methods: This study analyzed consecutive patients who underwent minimally invasive surgery for stage I-III rectal cancer between April 2014 and October 2020. After propensity score matching (PSM), short-term outcomes, relapse-free survival, and overall survival were compared between the robotic surgery (RS) group and the laparoscopic surgery (LS) group.

Results: During the study period, 251 patients underwent laparoscopic surgery and 193 underwent robotic surgery. PSM resulted in 160 matched pairs (After PSM, the percentages of patients with stage I, II, and III disease were respectively 56%, 19%, and 24% in the LS group and 49%, 23%, and 28% in the RS group (P = 0.462). Median operation time was 239 min in the LS group and 284 min in the RS group (P = 0.001). The C-reactive protein level on postoperative day 3 was significantly lower in the RS group (4.63 mg/mL vs. 5.86 mg/mL, P = 0.013). Postoperative complications, including ileus and Clavien-Dindo grade II or higher complications, were 6% vs. 1% (P = 0.006) and 21% vs. 12% (P = 0.024) in the LS and RS groups, respectively. The 5-year relapse-free survival rate was 88.5% in the LS group and 90.5% in the RS group (P = 0.525); the respective 5-year overall survival rates were 97.3 and 93.8% (P = 0.283). The 5-year cumulative local and distant recurrence rates were 3.3% vs. 3.3% (P = 0.665) and 9.7% vs. 7.7% (P = 0.464) in the LS and RS groups, respectively CONCLUSION: Robotic surgery can be a feasible treatment modality for rectal cancer, with lower frequencies of postoperative ileus and Clavien-Dindo grade II or higher complications than laparoscopic surgery and no difference in long-term outcomes.

Keywords: Laparoscopic surgery; Postoperative outcomes; Propensity score analysis; Rectal cancer; Robotic surgery.

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Conflict of interest statement

Declarations. Disclosures: Dr. Takeharu Kato, Dr. Hiroshi Nagata, Dr. Konosuke Moritani, and Dr. Yukihide Kanemitsu have no conflicts of interest to disclose. Dr. Yasuyuki Takamizawa and Dr. Shunsuke Tsukamoto report speakers consultancy fees from Intuitive Surgical, Inc.

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