Effect of surgical risk factors on the short-term outcomes for rectal cancer surgery. Laparoscopic or robotic approach?

Laparoscopic surgery for rectal cancer is technically complex, difficult to master, and also has a rather high risk of conversion rate, especially in patients with high surgical risk. The advantages of the robotic system make this approach the preferred for rectal surgery. The aim of the study is to compare the short-term outcomes of robot-assisted and laparoscopic rectal cancer surgery in high-risk patients.

Materials and methods. This work is a retrospective study based on the analysis of 463 case histories of patients with
tumors localized in the rectum, who underwent robot-assisted and laparoscopically-assisted operations in the period from
2015 to 2021 in the department of abdominal oncology, St. Petersburg State Budgetary Institution of Healthcare City Hospital
No.40 (Saint-Petersburg) and in the 5th oncology department of the Clinical Oncological Dispensary No.1 (Krasnodar).
The patients were divided into several subgroups depending on the presence of high surgical risk factors. 240 patients
underwent laparoscopic-assisted surgery, 223 patients underwent robot-assisted intervention.

Results.Data analysis significantly (p<0.001) confirms the advantage of robot-assisted interventions in terms of such parameters
as intraoperative blood loss and hospytal stay of lents.
In the group of patients after neoadjuvant chemoradiation therapy who underwent robot-assisted surgery, the frequency
of better quality total mesorectumectomy was statistically significantly higher than in the group of patients who underwent
laparoscopic surgery (X2=5.132; p=0.024; OR=2.335 (95% CI 1.107; 4.925)). Also, in male patients, the quality of TME was
statistically significantly better in the group of robot-assisted operations (X2=8.219; p=0.005; OR=2.854 (95% CI 1.366; 5.962)).
In addition, there was a significant predominance of sphincter-preserving operations in the group of patients who underwent robot-assisted surgery. In the laparoscopic group, the frequency of abdominoperineal extirpations was 5 time shigher than in the robotic group (X2=54.703; p<0.001; OR=0.129 (95% CI 0.071; 0.236)). There was a statistically significant predominance of organ preserving operations in the group of robot-assisted surgery in patients with low-lying tumors (X2=53.885; p<0.001; OR=0.081 (95% CI 0.039; 0.167)), after NACRT (X2=31.302; p<0.001. OR=0.139 (95% CI 0.066; 0.293)),as well as in male patients (X2=25.994; p<0.001. OR=0.156 (95% CI 0.072; 0.338)).

Conclusions. Robot-assisted surgery for rectal cancer in a group of patients with high surgical risk shows advantages
over traditional laparoscopic techniques, demonstrating, first of all, a high rate of sphincter preservation, high quality TME,
reduced blood loss and shorter hospital stay.