Role of robotic surgery for rectal cancer: short-term, functional, and oncological outcomes for 150 consecutive patients

Introduction: Complete mesorectal excision to achieve a negative circumferential, distal resection margin and intact mesorectal excision is the ultimate goal of rectal cancer surgery. Although open surgery remains the “gold standard”, recent improvements in minimally invasive surgery (MIS) techniques like robotic surgeries have overcome many of the limitations of open and laparoscopic surgery. The purpose of this study was to evaluate the short-term, functional, and oncological outcomes of robotic surgery for rectal cancer at a single tertiary care center. Methods: This was a prospective, observational study conducted between December 2010 and January 2019. A total of 150 consecutive patients underwent robotic surgery for rectal cancer. Surgical outcomes, pathological results, and oncological results were investigated. Results: Patients had rectal adenocarcinoma located 30% in the upper rectum, 15% in the mid-rectum and 55% in the lower rectum. Seventy-five percent had received neoadjuvant chemoradiation. Average operative time including docking time and surgery time was 226.32 min (170-300 min), mean blood loss was 146.76 mL (120-200 mL), there were 5 conversions to open surgery. Bowel sounds appeared on average on the third day. All margins were negative in all patients; mesorectal grade was complete in 95% and near complete in 5%. Mean number of lymph nodes harvested was 9.5 (2-32). Complete pathological response rate was 39%. Two patients had anastomotic dehiscence after 1 month. Minor complications were noticed in 10% of patients. The overall complication rate for Clavien-Dindo classification grade III-IV was 3.0%. All had an acceptable quality of life and well-retained bladder function, with 18% having sexual dysfunction. Five-year DFS was 85% and OS was 94%. Local recurrence was 2.1%. Conclusion: We conclude that the robotic surgery for rectal cancer is a feasible procedure with low morbidity, a low conversion rate, and acceptable oncological results.