Robotic-assisted vs laparoscopic-assisted radical resection for rectal cancer: A comparison of surgical indices, postoperative recovery, and complications

Abstract

BACKGROUND

Although radical resection for rectal cancer (RC) is effective in tumor removal and recurrence prevention, further improvement is needed.

AIM

To comparatively analyze the effects of robotic-assisted radical resection (RARR) and laparoscopic-assisted radical resection (LARR) on surgical indicators, postoperative recovery, and complications in RC.

METHODS

A total of 200 patients with RC admitted between November 2023 and November 2025 were included. Patients were assigned to a laparoscopic group (n = 100, received LARR) or a robotic group (n = 100, RARR). Between-group comparative analyses were conducted across surgical indices (operation time, incision length, intraoperative blood loss, intraoperative transfusion, and prophylactic stoma), postoperative day 1 pain (Numeric Rating Scale), postoperative recovery indices (initial ambulation, time to urinary catheter removal, and hospitalization), gastrointestinal function (time to bowel sound recovery, first flatus, first liquid intake, and duration of abdominal distension), postoperative pathological indicators (mesorectal excision completeness, tumor length, differentiation, lymph node yield, T stage, N stage, and TNM stage), tumor markers (carcinoembryonic antigen and carbohydrate antigen 19-9/242), postoperative complications (bleeding, incision infection, rectovaginal fistula, voiding dysfunction, and anastomotic leakage), hospitalization expenses (surgical, total, and non-surgical expenses), and quality of life.

RESULTS

Compared with the laparoscopic group, the robotic group showed significantly shorter incision length (5.28 ± 1.50 cm vs 6.11 ± 1.70 cm), lower intraoperative blood loss [67.00 (44.25, 92.75) mL vs 119.50 (85.25, 149.00) mL], and faster gastrointestinal recovery, including shorter time to bowel sound recovery [3.00 (3.00, 4.00) days vs 3.50 (3.00, 4.00) days], first flatus [3.00 (3.00, 4.00) days vs 3.50 (3.00, 4.00) days], and first liquid intake (62.83 ± 23.29 hours vs 103.33 ± 36.10 hours), as well as shorter abdominal distension duration [4.00 (3.00, 4.75) days vs 4.00 (4.00, 5.00) days]. However, RARR was associated with higher surgical costs (2.91 ± 1.03 ten thousand CNY vs 1.79 ± 0.77 ten thousand CNY) and total hospitalization expenses (5.33 ± 1.45 ten thousand CNY vs 4.35 ± 1.45 ten thousand CNY). Quality-of-life scores were higher in the RARR group than in the LARR group. No significant differences were found between the two techniques in other indicators.

CONCLUSION

RARR offers clinical advantages over LARR for RC management, including shorter incision length, reduced intraoperative bleeding, faster gastrointestinal function recovery, and a superior quality of life, although it is associated with higher costs.

Keywords: Robotic-assisted radical resection of rectal cancer; Laparoscopic-assisted radical resection of rectal cancer; Surgical indicators; Postoperative recovery; Complications

Core Tip: This study compared robotic-assisted radical resection and laparoscopic-assisted radical resection for rectal cancer and found that robotic-assisted radical resection provides improved gastrointestinal function recovery and quality of life, with favorable surgical outcomes but higher costs.