Long-Term Outcomes of Robotic Versus Laparoscopic Total Mesorectal Excisions: A Propensity-Score Matched Cohort study of 5-year survival outcomes.

Objective: To compare long-term outcomes between laparoscopic and robotic total mesorectal excisions (TMEs) for rectal cancer in a tertiary center.

Background: Laparoscopic rectal cancer surgery has comparable long-term outcomes to the open approach, with several advantages in short-term outcomes. However, it has significant technical limitations, which the robotic approach aims to overcome.

Methods: We included patients undergoing laparoscopic and robotic TME surgery between 2013 and 2021. The groups were compared after propensity-score matching. The primary outcome was 5-year overall survival (OS). Secondary outcomes were local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and short-term surgical and patient-related outcomes.

Results: A total of 594 patients were included, and after propensity-score matching 215 patients remained in each group. There was a significant difference in 5-year OS (72.4% for laparoscopy 81.7% for robotic, 0.029), but no difference in 5-year LR (4.7% 5.2%, 0.850), DR (16.9% 13.5%, 0.390), or DFS (63.9% 74.4%, 0.086). The robotic group had significantly less conversion (3.7% 0.5%, 0.046), shorter length of stay [7.0 (6.0-13.0) vs 6.0 (4.0-8.0), < 0.001), and less postoperative complications (63.5% 50.7%, 0.010).

Conclusions: This study shows a correlation between higher 5-year OS and comparable long-term oncological outcomes for robotic TME surgery compared to the laparoscopic approach. Furthermore, lower conversion rates, a shorter length of stay, and a less minor postoperative complications were observed. Robotic rectal cancer surgery is a safe and favorable alternative to the traditional approaches.