Background/Objectives:Robotic-assisted surgery is an attractive and promising option with unique advantages in rectal cancer surgery, but the optimal surgical approach is still debatable. Therefore, we aimed to compare the short- and long-term outcomes of the robotic-assisted approach with the laparoscopic-assisted and open approaches.Methods:A single referral center in Israel retrospectively reviewed all patients that underwent an elective rectal resection for primary non-metastatic rectal cancer between 2010 and 2020. The cohort was separated into three groups according to the surgical approach: robotic, laparoscopic, or open.Results:The cohort included 526 patients with a median age of 64 years (range 31–89), of whom 103 patients were in the robotic group, 144 in the open group, and 279 patients in the laparoscopic group. The robotic group had significantly more lower rectal tumors (24.3% versus 12.7% and 6%, respectively,p< 0.001), more locally advanced tumors (65.6% versus 51.2% and 50.2%, respectively,p= 0.004), and higher rates of neoadjuvant radiotherapy (70.9% versus 54.2% and 39.5%, respectively,p< 0.001). Conversion to an open laparotomy was more common in the laparoscopy group (23.1% versus 6.8%, respectively,p= 0.001). The open approach had higher rates of intraoperative complications (23.2% compared with 10.7% and 13.5% in the robotic and laparoscopic groups, respectively,p= 0.011), longer hospital stays (10 days compared with 7 and 8 days, respectively,p< 0.001), and higher rates of postoperative complications (76% compared with 68.9% and 59.1%, respectively,p= 0.002). The groups were similar in the number of harvested lymph nodes (14) and the incidence of positive resection margins (2.1%). The 5-year overall survival in the robotic group was 92.3% compared with 90.5% and 88.3% in the laparoscopic and open groups, respectively (p= 0.12). The 5-year disease-free survival in the robotic group was 68% compared with 71% and 63%, respectively (p= 0.2).Conclusions:The robotic, laparoscopic, and open approaches had similar histopathological outcomes and long-term oncological outcomes. The open approach was associated with higher rates of perioperative morbidity. These findings suggest that the robotic approach is safe and effective in rectal cancer surgery.
背景/目的：机器人辅助手术因其独特优势成为直肠癌手术中颇具吸引力且前景广阔的选择，但最佳手术方式仍存争议。本研究旨在比较机器人辅助、腹腔镜辅助及开腹手术的近期与远期疗效。 方法：以色列某转诊中心回顾性分析了2010年至2020年间所有接受择期直肠切除术的原发性非转移性直肠癌患者。根据手术方式将队列分为三组：机器人组、腹腔镜组和开腹组。 结果：队列共纳入526例患者，中位年龄64岁（范围31-89岁），其中机器人组103例，开腹组144例，腹腔镜组279例。机器人组低位直肠肿瘤比例显著更高（分别为24.3% vs 12.7% vs 6%，p<0.001），局部进展期肿瘤更多（分别为65.6% vs 51.2% vs 50.2%，p=0.004），新辅助放疗率更高（分别为70.9% vs 54.2% vs 39.5%，p<0.001）。腹腔镜组中转开腹率更高（23.1% vs 6.8%，p=0.001）。开腹组术中并发症发生率更高（23.2% vs 机器人组10.7%和腹腔镜组13.5%，p=0.011），住院时间更长（10天 vs 7天和8天，p<0.001），术后并发症发生率更高（76% vs 68.9%和59.1%，p=0.002）。三组在淋巴结获取数量（14枚）和切缘阳性率（2.1%）方面无显著差异。机器人组5年总生存率为92.3%，腹腔镜组为90.5%，开腹组为88.3%（p=0.12）；5年无病生存率分别为68%、71%和63%（p=0.2）。 结论：机器人、腹腔镜与开腹手术在组织病理学结果和远期肿瘤学结局方面具有相似性。开腹手术与更高的围手术期并发症发生率相关。这些发现表明机器人手术在直肠癌治疗中是安全有效的。
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