Skip to main content


Log in

Short- and long-term outcomes of robotic surgery for rectal cancer: a single-center retrospective cohort study

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript



This study aimed to clarify the short- and long-term outcomes of robotic surgery with or without lateral lymph node dissection (LLND) for rectal cancer at Fujita Health University Hospital, Aichi, Japan, during a self-pay period.


We retrospectively evaluated 115 consecutive patients who underwent robotic surgery for rectal cancer between September 2009 and March 2018, with a median follow-up period of 48 months. Total mesorectal excision was completed by two certified surgeons using a da Vinci S, Si, or Xi Surgical System with an entirely robotic single-docking technique. The surgical and pathological outcomes, morbidity, and oncological results were examined.


Lateral lymph node dissection was performed in 26 patients (22.6%). Neither conversion to open surgery nor perioperative blood transfusion occurred. Ten patients (8.7%) experienced Clavien–Dindo grade III postoperative complications. Pathologically, both the distal and radial margins were negative in all cases. The 5-year relapse-free survival rates for stages I, II, III, and IV were 93.5%, 100%, 83.8%, and not reached, respectively.


Even in the period before coverage by the health insurance system, robotic surgery for rectal cancer performed by experienced surgeons was safe and technically feasible, with favorable perioperative results and long-term oncological outcomes, including rates of the relapse-free survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Bandoh T, Shiraishi N, Yamashita Y, Terachi T, Hashizume M, Akira S, et al. Endoscopic surgery in Japan: the 12th national survey (2012–2013) by the Japan Society for Endoscopic Surgery. Asian J Endosc Surg. 2017;10:345–53.

    Article  Google Scholar 

  2. Shiroshita H, Inomata M, Bandoh T, Uchida H, Akira S, Hashizume M, et al. Endoscopic surgery in Japan: the 13th national survey (2014–2015) by the Japan Society for Endoscopic Surgery. Asian J Endosc Surg. 2019;12:7–18.

    Article  Google Scholar 

  3. Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2018;23:1–34.

    Article  Google Scholar 

  4. Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg. 2019;269:589–95.

    Article  Google Scholar 

  5. Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA. 2015;314:1356–63.

    Article  CAS  Google Scholar 

  6. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA. 2017;318:1569–80.

    Article  Google Scholar 

  7. Simillis C, Tekkis PP. Robotic versus laparoscopic surgery for rectal cancer: an evidence-based approach. Ann Surg. 2018.

    Article  Google Scholar 

  8. Polat F, Willems LH, Dogan K, Rosman C. The oncological and surgical safety of robot-assisted surgery in colorectal cancer: outcomes of a longitudinal prospective cohort study. Surg Endosc. 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Phan K, Kahlaee HR, Kim SH, Toh JWT. Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies. Tech Coloproctol. 2019;23:221–30.

    Article  CAS  Google Scholar 

  10. Katsuno H, Maeda K, Hanai T, Masumori K, Matsuoka H, Uyama I, et al. A novel approach of robot surgery for colorectal cancer. Jpn J Gastroenterol Surg. 2010;43:1002–6.

    Article  Google Scholar 

  11. Kanehara & Co., Ltd. Japanese society for cancer of the colon and rectum. Japanese classification of colorectal carcinoma. Tokyo: Kanehara & Co., Ltd; 2009 (2nd English ed).

    Google Scholar 

  12. Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of the malignant tumours. 8th ed. Chichester: Wiley; 2017.

    Google Scholar 

  13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  14. Feroci F, Vannucchi A, Bianchi PP, Cantafio S, Garzi A, Formisano G, et al. Total mesorectal excision for mid and low rectal cancer: laparoscopic vs robotic surgery. World J Gastroenterol. 2016;22:3602–10.

    Article  Google Scholar 

  15. Aselmann H, Kersebaum JN, Bernsmeier A, Beckmann JH, Moller T, Egberts JH, et al. Robotic-assisted total mesorectal excision (TME) for rectal cancer results in a significantly higher quality of TME specimen compared to the laparoscopic approach-report of a single-center experience. Int J Colorectal Dis. 2018;33:1575–81.

    Article  Google Scholar 

  16. Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. 2011;25:855–60.

    Article  Google Scholar 

  17. Jiménez-Rodríiguez RM, Díaz-Pavón JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J. Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis. 2012;28:815–21.

    Article  Google Scholar 

  18. Morelli L, Di Franco G, Guadagni S, Rossi L, Palmeri M, Furbetta N, et al. Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si. Surg Endosc. 2018;32:589–600.

    Article  Google Scholar 

  19. Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC. Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19:2095–101.

    Article  Google Scholar 

  20. Huang YJ, Kang YN, Huang YM, Wu AT, Wang W, Wei PL. Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: an update systematic review and meta-analysis of randomized controlled trials. Asian J Surg. 2019;42:657–66.

    Article  Google Scholar 

  21. Mori T, Kimura T, Kitajima M. Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol. 2010;19:18–23.

    Article  Google Scholar 

  22. Crolla R, Mulder PG, van der Schelling GP. Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? An observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections. Surg Endosc. 2018;32:4562–70.

    Article  Google Scholar 

  23. Tang B, Zhang C, Li C, Chen J, Luo H, Zeng D, et al. Robotic total mesorectal excision for rectal cancer: a series of 392 cases and mid-term outcomes from a single center in China. J Gastrointest Surg. 2017;21:569–76.

    Article  Google Scholar 

  24. Law WL, Foo DCC. Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer. Surg Endosc. 2017;31:2798–807.

    Article  Google Scholar 

  25. Hara M, Sng K, Yoo BE, Shin JW, Lee DW, Kim SH. Robotic-assisted surgery for rectal adenocarcinoma: short-term and midterm outcomes from 200 consecutive cases at a single institution. Dis Colon Rectum. 2014;57:570–7.

    Article  Google Scholar 

  26. Pridgeon S, Bishop CV, Adshead J. Lower limb compartment syndrome as a complication of robot-assisted radical prostatectomy: the UK experience. BJU Int. 2013;112:485–8.

    Article  Google Scholar 

  27. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372:1324–32.

    Article  CAS  Google Scholar 

  28. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Lapalorcia LM, Casciola L. Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg. 2009;16:450–7.

    Article  Google Scholar 

  29. Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49:1663–72.

    Article  Google Scholar 

  30. Sato H, Maeda K, Maruta M. Prognostic significance of lateral lymph node dissection in node positive low rectal carcinoma. Int J Colorectal Dis. 2011;26:881–9.

    Article  Google Scholar 

  31. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.

    Article  CAS  Google Scholar 

  32. Maeda K, Hanai T, Sato H, Masumori K, Koide Y, Matsuoka H, et al. Intraluminal exfoliated cancer cells and effectiveness of bowel ligatures during sigmoidectomy for sigmoid colon cancer. Surg Today. 2014;44:297–301.

    Article  Google Scholar 

  33. Hu Y, Feit N, Huang Y, Xu W, Zheng S, Li X. Gastrointestinal metastasis of primary lung cancer: an analysis of 366 cases. Oncol Lett. 2018;15:9766–76.

    PubMed  PubMed Central  Google Scholar 

  34. Kim J, Baek SJ, Kang DW, Roh YE, Lee JW, Kwak HD, et al. Robotic resection is a good prognostic factor in rectal cancer compared with laparoscopic resection: long-term survival analysis using propensity score matching. Dis Colon Rectum. 2017;60:266–73.

    Article  Google Scholar 

Download references


The authors would like to thank MARUZEN-YUSHODO Co., Ltd. ( for the English language editing.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Hidetoshi Katsuno.

Ethics declarations

Conflict of interest

We declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Katsuno, H., Hanai, T., Masumori, K. et al. Short- and long-term outcomes of robotic surgery for rectal cancer: a single-center retrospective cohort study. Surg Today 50, 240–247 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: