Journal of Gastrointestinal & Digestive System
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Our aim of this study is to compare the short and long- term outcomes between robotic and laparoscopic ultra low anterior
resection and coloanal anastomosis (with or without intersphincteric resection).
Methods & Materials:
Between January 2007 and December 2010, a retrospective chart review of all patients diagnosed with low
rectal cancer that underwent curative ultra low anterior resection and coloanal anastomosis with or without intersphincteric resection
using either robotic or laparoscopic approach. Inclusion criteria were as follows: mid or low rectal cancer, with or without neoadjuvant
chemoradiation therapy, laparoscopic and robotic approach. Exclusion criteria: Open approach, tumors invading the levator ani or
external sphincter, T4 cancers invading the prostate and vagina that did not respond to neoadjuvant treatment. Morbidity was stratified
by Accordion severity grading system of surgical complications.
A total of 84 consecutive patients with low rectal cancer who underwent curative robotic or laparoscopic-assisted ultra low
anterior resection and coloanal anastomosis with or without intersphincteric resection have been studied. 47 of them had robotic and
37 laparoscopic procedure.
Patient characteristics were not significantly different between the groups. The median follow-up was 31.5 months. There was no
perioperative mortality. The complication rates were similar in robotic and laparoscopic groups (19.1% vs. 27.0%, P: 0.439). However,
the conversion rate was 2.1% in the robotic group and 16.2% in the laparoscopic group (P:0.02). Robotic group had shorter hospital
stay than laparoscopic one (9 days vs. 11 days, P:0.011). The local recurrence rates were similar in both groups (Robotic, 6.4% vs.
Laparoscopic, 5.4%; P:1.00). The 3-year disease-free survival for all stages was 80.6% in the robotic group and 81.2% in the laparoscopic
group (P:0.914) and the 3-year overall survival was 86.5% in the robotic group and 90.7% in the laparoscopic one (P:0.404).
Robotic ultra low anterior resection and coloanal anastomosis with or without ISR is safe and feasible surgical approach with
similar oncological outcomes, shorter hospital stay and low conversion rate than laparoscopic approach. However, further prospective
and case-control cohort studies with longer follow-up are required.
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