Comparison of the postoperative outcomes between the robotic transabdominal approach alone and the combined robotic transabdominal and conventional transanal approach for rectal cancer.

Purpose: We aimed to compare the safety, feasibility, required human resources, and surgical costs of a combined robotic transabdominal and conventional transanal (TaRob) approach with those of a robotic transabdominal approach alone for rectal cancer.

Methods: Forty-nine patients who underwent robotic surgery for rectal cancer were retrospectively enrolled and categorized into two groups: robotic transabdominal approach alone (Rob-alone, n = 29) and TaRob approach (TaRob, n = 20). Patient characteristics, short-term postoperative outcomes, human resources, and surgical costs were compared between the groups.

Results: The tumor distance from the anal verge was shorter and preoperative treatment was performed more frequently in the TaRob group. The total operation time was shorter in the TaRob group (258 vs. 325 min), with no between-group differences in postoperative complications or pathological outcomes. Although the TaRob group required more staff than the Robot-alone group, the staff time consumed did not differ. The TaRob group had higher surgical costs for consumables than the robot alone group. These results were consistent before and after performing propensity score matching.

Conclusions: The combined approach after preoperative treatment for low rectal cancer resulted in a reduced operation time without any increased postoperative complications. The combined approach increased surgical costs, but could potentially reduce staff work hours, provided that sufficient staff is available.