Comparative Outcomes of Robot-assisted Versus Laparoscopic Low Anterior Resection in Mid-to-low Rectal Cancer: A Propensity Score-matched Study on Complications and Permanent Stoma Rates.
{"title":"Comparative Outcomes of Robot-assisted <i>Versus</i> Laparoscopic Low Anterior Resection in Mid-to-low Rectal Cancer: A Propensity Score-matched Study on Complications and Permanent Stoma Rates.","authors":"Hsin Hsu, Jeng-Fu You, Chun-Kai Liao, Tzong-Yun Tsai, Shu-Huan Huang","doi":"10.21873/invivo.14037","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/aim: </strong>While some research has revealed the potential short-term advantages of robot-assisted low anterior resection (LAR) in patients with mid-to-low rectal cancer, studies focusing on the permanent stoma rate remain limited.</p><p><strong>Patients and methods: </strong>We conducted a retrospective analysis on a continuous series of patients with non-metastatic mid-to-low rectal cancer. Between 2016 and 2020, these patients underwent either robot-assisted or traditional laparoscopic LAR at a single center. We used a propensity score matching technique, and the participants were matched in a 1:2 ratio and a caliper of 0.05.</p><p><strong>Results: </strong>After matching, our cohort consisted of 44 patients from the robot-assisted LAR group and 88 from the laparoscopic LAR group. The long-term results, such as overall survival, cancer-free survival, and local and distant recurrence rates were similar between the two groups. However, the robot-assisted group exhibited a notably shorter average post-surgery hospitalization (10.8 <i>vs</i>. 16.7 days, <i>p</i>=0.001), reduced incidence of anastomotic leakage (11.4% <i>vs</i>. 37.5%, <i>p</i><0.001), fewer patients requiring a permanent stoma (13.6% <i>vs</i>. 29.5% <i>p</i>=0.044), and significantly lower occurrences of grade III Clavien-Dindo surgical complications. Furthermore, the robot-assisted procedures had a diminished frequency of firing three or more staplers (2.3% <i>vs</i>. 26.1%, <i>p</i>=0.001). A multivariate logistic regression indicated that robot-assisted LAR is independently associated with a reduced risk of permanent stoma (odds ratio=0.28, <i>p</i>=0.033, 95% confidence interval=0.087-0.901).</p><p><strong>Conclusion: </strong>In patients with mid-to-low rectal cancer, robot-assisted LAR, despite comparable long-term survival and recurrence rates, displayed reduced complications, including fewer instances of anastomotic leakage and permanent stoma requirements than its laparoscopic counterpart. These findings imply the potential superiority of robot-assisted surgical techniques for mid-to-low rectal patients.</p>","PeriodicalId":13364,"journal":{"name":"In vivo","volume":"39 4","pages":"2387-2396"},"PeriodicalIF":1.8000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"In vivo","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21873/invivo.14037","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background/aim: While some research has revealed the potential short-term advantages of robot-assisted low anterior resection (LAR) in patients with mid-to-low rectal cancer, studies focusing on the permanent stoma rate remain limited.
Patients and methods: We conducted a retrospective analysis on a continuous series of patients with non-metastatic mid-to-low rectal cancer. Between 2016 and 2020, these patients underwent either robot-assisted or traditional laparoscopic LAR at a single center. We used a propensity score matching technique, and the participants were matched in a 1:2 ratio and a caliper of 0.05.
Results: After matching, our cohort consisted of 44 patients from the robot-assisted LAR group and 88 from the laparoscopic LAR group. The long-term results, such as overall survival, cancer-free survival, and local and distant recurrence rates were similar between the two groups. However, the robot-assisted group exhibited a notably shorter average post-surgery hospitalization (10.8 vs. 16.7 days, p=0.001), reduced incidence of anastomotic leakage (11.4% vs. 37.5%, p<0.001), fewer patients requiring a permanent stoma (13.6% vs. 29.5% p=0.044), and significantly lower occurrences of grade III Clavien-Dindo surgical complications. Furthermore, the robot-assisted procedures had a diminished frequency of firing three or more staplers (2.3% vs. 26.1%, p=0.001). A multivariate logistic regression indicated that robot-assisted LAR is independently associated with a reduced risk of permanent stoma (odds ratio=0.28, p=0.033, 95% confidence interval=0.087-0.901).
Conclusion: In patients with mid-to-low rectal cancer, robot-assisted LAR, despite comparable long-term survival and recurrence rates, displayed reduced complications, including fewer instances of anastomotic leakage and permanent stoma requirements than its laparoscopic counterpart. These findings imply the potential superiority of robot-assisted surgical techniques for mid-to-low rectal patients.
期刊介绍:
IN VIVO is an international peer-reviewed journal designed to bring together original high quality works and reviews on experimental and clinical biomedical research within the frames of physiology, pathology and disease management.
The topics of IN VIVO include: 1. Experimental development and application of new diagnostic and therapeutic procedures; 2. Pharmacological and toxicological evaluation of new drugs, drug combinations and drug delivery systems; 3. Clinical trials; 4. Development and characterization of models of biomedical research; 5. Cancer diagnosis and treatment; 6. Immunotherapy and vaccines; 7. Radiotherapy, Imaging; 8. Tissue engineering, Regenerative medicine; 9. Carcinogenesis.