International Journal of Colorectal Disease

, Volume 31, Issue 6, pp 1179–1187 | Cite as

Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted, and robot-assisted approaches in rectal cancer patients

  • Jin Cheon KimEmail author
  • Chang Sik Yu
  • Seok-Byung Lim
  • In Ja Park
  • Chan Wook Kim
  • Yong Sik Yoon
Original Article



Because there are few comparative studies of open, laparoscopy-assisted (LA), and robot-assisted (RA) total mesorectal excision (TME) for rectal cancer, we aimed to compare these three procedures in terms of sphincter-saving operation (SSO) achievement, surgical complications, and early oncological outcomes.


The short-term outcomes of 2114 patients with rectal cancer consecutively enrolled between July 2010 and February 2015 at Asan Medical Center (Seoul, Korea) were retrospectively evaluated. Patients underwent either open, LA, or RA TME (n = 1095, 486, and 533, respectively) performed by experienced surgeons.


RA TME was a significant determinant of SSO in multivariate analysis that included potential variables such as tumor location and T4 category (odds ratio, 2.458; 95 % confidence interval, 1.497–4.036; p < 0.001). The cumulative rates of 3-year local recurrence, overall survival, and disease-free survival did not differ among the three groups: 2.5–3.4, 91.9–94.6, and 82.2–83.1 % (p = 0.85, 0.352, and 0.944, respectively). Early general surgical complications occurred more frequently in the open group than in the LA and RA groups (19.3 versus 13.0 versus 12.2 %, p < 0.001), specifically ileus and wound infection.


There were no significant differences in 3-year survival outcomes and local recurrence among open, LA, and RA TME. RA TME is useful for SSO achievement, regardless of advanced stage and location of rectal cancer. The open procedure had a slightly but significantly higher incidence of postoperative complications than LA and RA.


Rectal cancer Open Laparoscopy Robot-assisted Comparative analysis 



This study was supported by grants (to J.C. Kim) from the Korea Research Foundation (2013R1A2A1A03070986), Ministry of Science, ICT, and Future Planning, and the Korea Health 21 R&D Project (HI06C0868 and HI13C1750), Ministry of Health, Welfare, and Family Affairs, Republic of Korea. We gratefully acknowledge the expert assistance of Dr. J. Y. Lee, Mr. Y. J. Yoon, Ms. J. R. Kim, and H. J. Jung.

Compliance with ethical standards

All patients provided written informed consent, and the study protocol was approved by the Institutional Review Board of Asan Medical Center (registration number: 2015-0973) in accordance with the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflict of interest.

Role of the funding source


Supplementary material

384_2016_2586_Fig2_ESM.gif (38 kb)
Supplementary Fig. 1

Mean fold ratios of basic manometric parameters of evaluable patients (open/LA/RA groups: n = 182/52/251 patients). The data represent the ratios of the values obtained at 6–12 postoperative months to the preoperative values and were compared using an analysis or variance (ANOVA) test. MRP, maximal resting pressure; MSP, maximal squeezing pressure; UDV, urge to defecate volume; MTV, maximal tolerance volume. (GIF 37 kb)

384_2016_2586_MOESM1_ESM.tif (446 kb)
High Resolution Image (TIF 446 kb)
384_2016_2586_Fig3_ESM.gif (58 kb)
Supplementary Fig. 2

Overall survival (a–c) and disease-free survival (d–f) of the open, LA, and RA groups according to the respective stage. Survival outcomes were compared using the Kaplan–Meier method with the log-rank test. LA, laparoscopy-assisted; RA, robot-assisted; OS, overall survival; DFS, disease-free survival. (GIF 57 kb)

384_2016_2586_MOESM2_ESM.tif (1.5 mb)
High Resolution Image (TIF 1523 kb)
384_2016_2586_MOESM3_ESM.docx (28 kb)
Table S1 Parameters associated with SSO achievementa (DOCX 27 kb)
384_2016_2586_MOESM4_ESM.docx (26 kb)
Table S2 Parameters associated postoperative ileus and anastomotic complicationsa (DOCX 25 kb)
384_2016_2586_MOESM5_ESM.docx (24 kb)
Table S3 Parameters associated 3-year local recurrence (DOCX 24 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Jin Cheon Kim
    • 1
    • 2
    Email author
  • Chang Sik Yu
    • 1
  • Seok-Byung Lim
    • 1
  • In Ja Park
    • 1
  • Chan Wook Kim
    • 1
  • Yong Sik Yoon
    • 1
  1. 1.Department of SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulKorea
  2. 2.Institute of Innovative Cancer ResearchAsan Medical CenterSeoulKorea

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