Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of long-term outcomes

J Robot Surg. 2020 Jun;14(3):393-399. doi: 10.1007/s11701-019-01001-5. Epub 2019 Jul 16.


The aim of our study was to compare long term outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision (TME) in male patients with mid-low rectal cancer (RC) after neoadjuvant chemoradiotherapy (NCRT). The study was conducted as a retrospective review of a prospectively maintained database, and we analyzed 14 robotic and 65 laparoscopic sphincter-saving TME (R-TME and L-TME, respectively) performed by one surgeon between 2005 and 2013. Patient characteristics, perioperative recovery, postoperative complications and pathology results were compared between the two groups. The patient characteristics did not differ significantly between the two groups. Median operating time was longer in the R-TME than in the L-TME group (182 min versus 140 min). Only two conversions occurred in the L-TME group. No difference was found between groups regarding perioperative recovery and postoperative complication rates. The median number of harvested lymph nodes was higher in the RTME than in the L-TME group (32 versus 23, p = 0.008). The median circumferential margin (CRM) was 10 mm in the R-TME group, 6.5 mm in the L-TME group (p = 0.047. The median distal resection margin (DRM) was 27.5 mm in the R-TME, 15 mm in the L-TME group (p = 0.014). Macroscopic grading of the specimen in the R-TME group was complete in all patients. In the L-TME group, grading was complete in 52 (80%) and incomplete in 13 (20%) cases (p = 0.109). Median follow-up 87 months (1-152). Whereas local recurrence was seen in eight cases (10.12%) and distant metastasis was seen in 18 cases (22.7%). Overall, 5 years survival was 83.3% in R-TME, 75% in L-TME groups. R-TME is a safe and feasible procedure that facilitates performing of TME in male patients with mid to low RC after NCRT.

Keywords: Laparoscopic; Rectal cancer; Robotic; Sphincter-saving procedure; Total mesorectal excision.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anal Canal*
  • Chemoradiotherapy, Adjuvant*
  • Digestive System Surgical Procedures / methods*
  • Feasibility Studies
  • Follow-Up Studies
  • Humans
  • Laparoscopy / methods*
  • Male
  • Margins of Excision
  • Metabolism, Inborn Errors
  • Middle Aged
  • Neoadjuvant Therapy*
  • Operative Time
  • Organ Sparing Treatments / methods*
  • Rectal Neoplasms / surgery*
  • Rectal Neoplasms / therapy
  • Retrospective Studies
  • Robotic Surgical Procedures / methods*
  • Sex Factors
  • Time Factors
  • Treatment Outcome

Supplementary concepts

  • Combined Malonic and Methylmalonic Aciduria