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Multicenter Study
. 2025 Sep;51(9):110180.
doi: 10.1016/j.ejso.2025.110180. Epub 2025 May 20.

Impact of minimal invasive surgery techniques on long-term health-related quality of life in rectal cancer: a Dutch cohort study

David M Mens  1 , Jan M van Rees  2 , Olga Husson  3 , Rogier M P H Crolla  4 , Denise E Hilling  2 , Cornelis Verhoef  2 , Esther J C Consten  5 , Robert R J Coebergh van den Braak  6 ; PLCRC Study Group
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Free article
Multicenter Study

Impact of minimal invasive surgery techniques on long-term health-related quality of life in rectal cancer: a Dutch cohort study

David M Mens et al. Eur J Surg Oncol. 2025 Sep.
Free article

Abstract

Objective: Limited data exists on health-related quality of life (HRQoL) after robot-assisted surgery (RAL) for rectal cancer beyond one-year post-surgery. This study compares long-term HRQoL following RAL total mesorectal excision (TME) to conventional laparoscopic (CL) TME.

Methods: All rectal carcinoma patients from the 63-center Prospective National CRC cohort (PLCRC) who completed pre- and post-operative HRQoL questionnaires (EQ-5D, QLQ-C30, and QLQ-CR29) were retrospectively included. Delta scores per parameter were calculated by subtracting pre-operative scores from scores at one year. Sensitivity analysis included all patients with beyond one-year post-operative questionnaires, regardless of a pre-operative questionnaire. Data were analyzed using multivariate linear regression.

Results: Patients undergoing RAL TME more often had low rectal tumors, more post-operative complications and more stomas. In patients with both pre- and post-operative questionnaires, no significant differences were found in the EQ-5D delta score (n = 591). The QLQ-C30 (n = 709) showed statistically significant and clinical relevant difference in fatigue favored CL TME (4.4 ± 1.9, p = 0.021). The QLQ-CR29 (n = 696) showed small, statistically significant differences favoring RAL in body image and stoma-related issues, but no clinical relevance. Sensitivity analysis EQ-5D (n = 1250), QLQ-C30 (n = 1423) or QLQ-CR29 (n = 1453) showed no clinically relevant differences.

Conclusion: This is the first study comparing long-term HRQoL between CL and RAL surgery for rectal cancer. Although several statistically significant differences were found, no clinically relevant differences were observed except for a small difference in the subdomain fatigue of the EORTC QLQ-C30 favoring CL surgery. Furthermore, the current study underlines the relevance of a pre-operative HRQoL assessment.

Keywords: Health-related quality of life; Minimal invasive surgery; Rectal cancer.

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Conflict of interest statement

Declaration of competing interest All the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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