Comparison of the efficacy and safety of single-port versus multi-port robotic total mesorectal excision for rectal cancer: A propensity score-matched analysis

Background: It is unknown whether the da Vinci single-port system performs similarly to the previous multi-port system during complicated procedures, such as rectal cancer surgery. Therefore, we compared the short-term clinical outcomes of single-port and multi-port robotic total mesorectal excision for the treatment of rectal cancer. Methods: This retrospective study reviewed 128 patients who underwent robotic total mesorectal excision between July 2020 and June 2022, of whom 84 (42 each: single-port versus multi-port) were included in the propensity score-matched cohort. Perioperative and pathologic outcomes were compared between groups. Results: Median tumor height was similar between groups (single-port versus multi-port, 5.9 +/- 2.1 vs 5.6 +/- 1.8 cm, P = .719). Preoperative chemoradiotherapy was performed equally. The total operative time was less (160.0 +/- 42.2 minutes vs 199.6 +/- 78.6 minutes, P = .005), the total length of incision was shorter (4.0 +/- 0.3 vs 5.4 +/- 0.7 cm, P = .003), postoperative hospital stay was shorter (6.2 +/- 1.7 vs 7.2 +/- 2.8 days, P = .050), and C-reactive protein levels on postoperative day 3 trended to be lower (7.3 +/- 4.7 vs 8.9 +/- 5.6 mg/ L, P = .096) in the single-port group, compared with the multi-port group. Postoperative complications did not differ between groups (single-port versus multi-port, 11.9% vs 16.6%, P = .864). Anastomotic leakage occurred in 1 and 2 patients in the single-port and multi-port groups, respectively. The circumferential resection margins were positive in 1 patient in the multi-port group. Conclusion: The perioperative outcomes of single-port robotic total mesorectal excision were comparable to those of multi-port robotic TME. The single-port robot can be considered a surgical option for treating rectal cancer.