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Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis

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Abstract

Robotic-assisted surgery (RAS) is becoming increasingly common for the surgical treatment of rectal cancer. However, the use and implementation of robotic surgery remains controversial. This study aimed to compare the short-term outcomes of robotic surgery, focusing on pathological results and disease-free survival (DFS), in our cohort with initial robotic experience by multiple surgeon implementation. This retrospective study enrolled 571 patients diagnosed with rectal cancer, who were treated with chemoradiotherapy and surgery between January 2015 and December 2021. Surgical outcomes after RAS and laparoscopic surgery (LS) were compared using a propensity score-matching (PSM) analysis. After matching, 200 patients (100 in each group) were included. The median operative time was significantly longer in the RAS group than in the LS group (p < 0.001). The conversion and morbidity rates were similar between the groups. A significantly higher rate of complete mesorectal excision (92% vs. 72%; p = 0.001) and number of lymph nodes harvested (p = 0.009) was observed in the RAS group. There were no statistically significant differences between the groups regarding circumferential and distal resection margin involvement. The 3-year overall and disease-free survival rate was similar between the two groups (p = 0.849 and p = 0.582, respectively). Two patients in the LS group developed local recurrence and 27 patients (15.4%) developed metastatic disease. Multivariate analysis showed that tumor stage III was the only factor associated with disease-free survival (HR, 9.34; (95% CI 1.13–77.1), p = 0.038). RAS and LS showed similar outcomes in terms of perioperative, anatomopathological, and disease-free survival, after multiple surgeon implementations.

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Acknowledgements

We thank Anastasia Glagolieva, who collaborated to facilitate this project.

Funding

Dr. Ernesto Barzola, MsC. Lidia Cornejo, Dr. Núria Gòmez, Dr. Anna Pigem, Dr. David Julià, Dr.Nuria Ortega, Dr. Olga Delisau, Dr. Kelly-Ann Bobb, Dr.Ramon Farrès, and Dr.Pere Planellas have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain

    E. Barzola, N. Gómez, A. Pigem, D. Julià, N. Ortega, O. Delisau, R. Farrés & P. Planellas

  2. Girona Biomedical Research Institute (IDIBGI), Girona, Spain

    L. Cornejo

  3. Department of Clinical Surgical Sciences, Faculty of Medical Sciences, University of the West Indies-St. Augustine, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad, West Indies, Trinidad and Tobago

    K. A. Bobb

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  1. E. Barzola
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Contributions

EB: study conception and design, literature review, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision and final approval of the manuscript. PP: study conception and design, literature review, acquisition of data, analysis, and interpretation of data, drafting of the manuscript, critical revision, and final approval of the manuscript. LC: analysis and interpretation of data, critical revision, and final approval of the manuscript. NG: analysis and interpretation of data, critical revision, and final approval of the manuscript. AP: analysis and interpretation of data, critical revision, and final approval of the manuscript. OD: analysis and interpretation of data, critical revision, and final approval of the manuscript. NO: analysis and interpretation of data, critical revision, and final approval of the manuscript. K-AB: analysis and interpretation of data, critical revision, and final approval of the manuscript. RF: study conception and design, literature review, analysis and interpretation of data, critical revision, and final approval of the manuscript. All authors agree to be held accountable for all aspects of this work.

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Correspondence to P. Planellas.

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Conflict of interest

Dr. Ernesto Barzola, MsC. Lidia Cornejo, Dr. Núria Gómez, Dr. Anna Pigem, Dr. David Julià, Dr.Nuria Ortega, Dr. Olga Delisau, Dr. Kelly-Ann Bobb, Dr.Ramon Farrés, and Dr.Pere Planellas have no conflicts of interest regarding the publication of this article.

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This study was approved by the hospital’s ethics committee and conducted in accordance with the 1964 Helsinki Declaration and its later amendments. (N °2022.164).

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All patients provided written informed consent to collect data and authorize the analysis of the results.

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Barzola, E., Cornejo, L., Gómez, N. et al. Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis. J Robotic Surg 17, 3013–3023 (2023). https://doi.org/10.1007/s11701-023-01736-2

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