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.

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.