Robotic surgery for colorectal cancer has been slower to become established than in other specialties. This study outlines the outcomes from laparoscopic and robotic surgery performed by a subspecialist rectal cancer team in a District General Hospital.
Outcomes from consecutive patients undergoing minimal access rectal cancer surgery between July 2008 and January 2020 were analysed. Comparisons were made between short-term outcomes including conversion rates, anastomotic leaks and pathological outcomes, as well as long-term survival and cancer recurrence.
337 patients were included for analysis, 204 (60.5%) underwent robotic surgery. Demographic characteristics and use of neo-adjuvant chemoradiotherapy were similar between groups. However, patients having robotic surgery had significantly lower tumours than in the laparoscopic group (7.6cm versus 9.8cm, p=0.003). Conversion to open surgery in the robotic group was significantly less likely (9.8% versus 22.6%, p=0.001). Operative mortality, clinical leakage, and major complications were similar between groups. While asymptomatic ‘radiological’ leaks were significantly more common following robotic surgery (13.7% versus 5.3%, p=0.017) this did not affect the long-term stoma-closure rate. Pathological outcomes were similar with the exception of shorter mean distal resection margins (25.9mm versus 32.8mm, p=0.001) for the robotic group of patients. There was no statistical difference in 5 year survival between groups (78.7% robotic versus 85.4% laparoscopic, p=0.263) nor local recurrence (2.0% robotic versus 3.8% laparoscopic, p=0.253).
These results illustrate how the selective use of robotic surgery by a dedicated rectal cancer team can achieve low rates of cancer recurrence and low permanent stoma rates.

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