Robotic versus laparoscopic total mesorectal excision for mid-low rectal cancer with difficult anatomical conditions

Objective: Laparoscopic total mesorectal excision (L-TME) is difficult to perform because of its technical shortcomings in cases of difficult anatomical condition. In such situations, robotic TME (R-TME) tends to be the procedure of choice. This study aimed to compare R-TME and L-TME treatments for mid-low rectal cancer in patients with difficult anatomical conditions. Methods: This retrospective single-center study examined data from 01/2019 to 02/2021 of mid-low rectal cancer patients with difficult anatomical conditions. Perioperative data, short-term outcomes, and 2-year oncologic outcomes were compared between groups. Results: The 106 patients were divided into R-TME (n = 56) and L-TME (n = 50). R-TME was associated with a lower diverting ileostomy rate (28.6% vs 50.0%, P = 0.005). R-TME involved a longer operation time (180 min vs 147.5 min, P < 0.001) but a similar procedure time (147.5 min vs 143.5 min, P = 0.110). More patients treated with R-TME experienced mild postoperative pain (33.9% vs 12.0%, P = 0.015) at a much higher cost ([$13740.8 +/- 2038.13] vs [$9579.97 +/- 2404.22], P < 0.001). The 2-year overall survival and disease-free survival rates were similar between the groups. Conclusion: R-TME, when performed by an experienced surgeon, can reduce the diverting ileostomy rate and relieve postoperative pain without a longer procedure time but at a higher cost. Larger trials of difficult patients with extended follow-up times are expected. (c) 2022 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).