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Multicenter Study
. 2025 May 16;19(1):222.
doi: 10.1007/s11701-025-02375-5.

Short-term clinical outcomes of open, laparoscopic, and robotic-assisted rectal resections: a multicenter real-world evidence study from Indian collaborative group on rectal resections (ICGRR)

A S Ramakrishnan  1 , Jagdish Kothari  2 , Surender Kumar Dabas  3 , Venkatesh Munnikrishnan  4 , O V Sudheer  5 , Jeewan Ram Vishnoi  6 , Shivendra Singh  7 , Jagannath Dixit  8 , Sandeep Nayak  9 , Ashwani Sharma  10 , Devendra Parikh  2 , Venkat Paneer  11 , Priya Kapoor  11 , S P Somashekhar  12 , Krishna M S Bharadwaj  13 , Divya Gupta  14 , Akhil Dahiya  15
Affiliations
Multicenter Study

Short-term clinical outcomes of open, laparoscopic, and robotic-assisted rectal resections: a multicenter real-world evidence study from Indian collaborative group on rectal resections (ICGRR)

A S Ramakrishnan et al. J Robot Surg. .

Abstract

This multi-centric real-world study was carried out to assess the perioperative and histopathological clinical outcomes of rectal resections employing open, laparoscopic, and robotic-assisted techniques. A retrospective chart review was undertaken for patients who underwent rectal resections for Stages I, II, and III rectal cancer (RC) between April 2012 and August 2023. All surgical procedures were performed with the principles of total mesorectal excision (TME) or partial mesorectal excision (for tumors located higher in the rectum). The study analyzed data from 829 patients of which 314 were in the robotic-assisted group (RAS), 206 in the laparoscopic surgery group (LG), and 309 in the open-surgery group (OG). The TNM staging and location of RC were evenly distributed across the three groups. The RAS group had a significantly lower length of hospital stay than LG and OG. Compared to LG and OG, the RAS group had less blood loss and postoperative complications, but significantly longer mean operating room time. The conversion rate of the RAS group was significantly lower than that of the LG group (p = 0.03). In comparison to the OG and LG groups, the RAS group had significantly lower (p < 0.05) rates of positive circumferential resection margin (CRM). Adjuvant treatment was administered in the RAS group significantly earlier (median, 24.5 days, IQR 18-37) compared to the LG (median, 31 days, IQR 23-41) and OG (median, 32.5 days, IQR 27-42). This largest multi‑centric study by the ICRR group has validated the value of a relatively newer technology like RAS in real-world Indian settings for rectal resections.

Keywords: Abdominoperineal resection; Laparoscopic group; Low anterior resection; Open group; Rectal resections; Robotic-assisted surgery.

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Conflict of interest statement

Declarations. Conflict of interest: AD and KB are employees of Intuitive Surgical, California, US. The other authors declare that they have no conflicts of interest concerning the publication of this work. The study was conducted independently, and the authors have no connections to, affiliations with, or financial relationships to any organizations that could unduly prejudice the content of this work. Ethics approval: The institutional ethics committee (IEC) or institutional review board (IRB) of each participating center granted permission for the study. The study was registered at the Clinical Trials Registry of India website with registration number CTRI/2023/03/050448. Consent to participate: Since this was a retrospective study that involved the collection of de-identified data without any direct participant interaction, the IRB/IEC waived the requirement for informed consent. Every study procedure conforms to the ethical norms of the participating institutions as well as the Declaration of Helsinki. Consent to publish: The corresponding author gives consent for this work to be published on behalf of all the authors. Financial interests: There are no financial interests of the authors that ought to be disclosed.

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