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Robotic vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting a median of 7-year long-term oncological and functional outcomes

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Abstract

Aim of this study was to compare operative, long-term oncological and functional outcomes of laparoscopic (LISR) and robotic (RISR) intersphincteric resection in low-lying rectal cancer. Retrospective analysis of prospectively maintained database was performed. 115 cases (LISR, n = 55; RISR, n = 60) were performed by a single surgeon (January 2011–January 2020). Clinical characteristics did not differ between the groups. Operating time was longer in RISR (160.0 ± 45.7 vs. 205.0 ± 36.5 min, p = 0.035). There was no conversion in RISR, whereas in LISR, two patients (3.6%) converted to open surgery. Complete mesorectum was 61.8% and 83.3% for LISR and RISR (p = 0.046), respectively. Circumferential radial margin involvement was 10.9% and 8.3% in LISR and RISR (p = 0.365), respectively. Median follow-up was 82.8 (30–138) months for LISR and 83.6 (30–138) months for RISR. Three-, five-, and seven-year overall survival rates (OS) for LISR and RISR were: 88.6%, 80.4%, 73.4% and 90.4%, 86.3%, 76.9%, respectively. Three-, five-, and seven-year disease-free survival (DFS) rates for LISR and RISR were 80.5%, 75.2%, 70.4% and 84.4%, 81.4%, 79.8% (p = 0.328), respectively. Three-, five-, and seven-year local recurrence-free survival rates in LISR and RISR were: 96.1%, 92.6%, 88.4% and 96.7%, 94.2%, 90.4% (p = 0.573), respectively. Mean Wexner score for LISR (n = 32) and RISR (n = 40) was: 10.5 ± 4.7 and 9.8 ± 4.2 (p = 0.782), respectively. Colostomy-free survival in LISR and RISR was: 3 years 94.5%/95.2%, 5 years 89.1%/91.7%, and 7 years 83.6%/85.0%. RISR is associated with better mesorectal integrity, no conversion, and lower postoperative complication rate. RISR has longer operation time. Oncological and anorectal functional outcomes are similar in both groups.

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Acknowledgements

We would like to express our gratitude to Aslan Aliyev (Eberhard Karls University, Germany) for his contribution to the statistical analysis.

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Authors and Affiliations

  1. Bogazici Academy for Clinical Sciences, General Surgery, Istanbul, Turkey

    Vusal Aliyev, Alisina Bulut & Oktar Asoglu

  2. Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Guglielmo Niccolò Piozzi

  3. Department of Radiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey

    Koray Guven

  4. Department of Radiology, Istanbul University Faculty of Medicine, Istanbul, Turkey

    Baris Bakir

  5. Department of Medical Oncology, Demiroglu Bilim University, Istanbul, Turkey

    Sezer Saglam

  6. Department of Pathology, Maslak Acibadem Hospital, Istanbul, Turkey

    Suha Goksel

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  1. Vusal Aliyev
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Contributions

Conceptualization: VA and OA; methodology: OA and VA; formal analysis and investigation: VA and GNP; writing—original draft preparation: VA, GNP, and AB; writing—review and editing: VA, GNP, KG, BB, SS, and SG; supervision: OA.

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Correspondence to Oktar Asoglu.

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Aliyev, V., Piozzi, G.N., Bulut, A. et al. Robotic vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting a median of 7-year long-term oncological and functional outcomes. Updates Surg 74, 1851–1860 (2022). https://doi.org/10.1007/s13304-022-01396-1

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