Comparison of Clinical Outcomes Between Da Vinci Robot-Assisted and Laparoscopic Intersphincteric Resection for Ultra-Low Rectal Cancer.

Abstract

Preserving anal function in ultra-low rectal cancer surgery remains challenging in terms of technique and perioperative management. With advancements in minimally invasive techniques, Da Vinci robot-assisted intersphincteric resection (ISR) has been increasingly utilized, yet its clinical benefits remain unclear. This retrospective cohort study included 142 patients who underwent ISR at the Second Xiangya Hospital of Central South University from January 2019 to December 2024, divided into the robot-assisted ISR (RoISR) group (n = 71) and the laparoscopic ISR (LaISR) group (n = 71). Perioperative outcomes, postoperative complications, pain scores (numerical rating scale [NRS]), Wexner scores, quality of life (Functional Assessment of Cancer Therapy-Colorectal [FACT-C] scale), and long-term survival outcomes were compared. Results showed that RoISR had a longer operative time (220.27 ± 32.21 versus 179.63 ± 23.88 minutes, P < .001) but earlier time to first flatus (1.77 ± 1.50 versus 2.32 ± 1.67 days, P = .041) and shorter hospital stay (8.25 ± 3.38 versus 9.77 ± 4.63 days, P = .027), with comparable blood loss and costs. The 30-day complication rate was lower in the RoISR group (7.04% versus 19.72%, P = .027), including reduced anastomotic complications (1.41% versus 5.63%) and bleeding (0% versus 4.23%). NRS pain scores were lower in the RoISR group at 12 hours (3.56 ± 0.84 versus 4.79 ± 1.11, P < .001), 24 hours (1.90 ± 0.85 versus 2.35 ± 1.02, P = .05), and 48 hours (1.07 ± 0.87 versus 1.61 ± 0.80, P < .001). Wexner scores showed greater improvement in the RoISR group at 3 months (9.49 ± 2.26 versus 10.45 ± 2.10, P = .01) and 6 months (7.18 ± 1.88 versus 7.94 ± 1.96, P = .02). Emotional functioning on the FACT-C scale was significantly better in the RoISR group (P = .028). Kaplan-Meier analysis indicated no significant differences in overall survival or recurrence-free survival (RFS) between groups. In conclusion, RoISR offers advantages in perioperative recovery, reduced complications, and improved aspects of quality of life, with long-term survival outcomes comparable to LaISR.