EP903 - Robotic Versus Laparoscopic Inter-sphincteric Resection for Low Rectal Cancer: A Comparative Analysis of Perioperative Outcomes

Purpose/Background: The management of low rectal cancer has progressively shifted towards organ preservation, with a growing focus on sphincter-preserving surgeries in the past decade. The robotic surgical platform offers potential advantages over laparoscopy in deep pelvic dissections, owing to its superior dexterity and seven degrees of freedom. However, whether these translate into improved perioperative outcomes remains uncertain.

Methods/Interventions: A retrospective analysis was conducted on patients who underwent inter-sphincteric resection (ISR) for low rectal cancer between 2013 and 2025 at our tertiary care center. Among 462 patients who underwent ISR, 391 cases were performed using minimally invasive techniques (laparoscopic or robotic). Patients were categorized into Robotic ISR (n = 110) and Laparoscopic ISR (n = 281) groups. Demographic details, tumor characteristics, intra-operative parameters, and perioperative outcomes were compared between the two groups.

Results/Outcomes: Baseline demographic and clinical characteristics, including neoadjuvant therapy usage, were comparable between the groups.

There was no significant difference in intraoperative blood loss (median 200 mL vs 250 mL in Robotic vs Laparoscopic group; p = 0.09) or conversion rates (0.9% vs 0.35%respectively).

The operative duration was significantly longer in the robotic group (median 350 minutes) compared with the laparoscopic group (median 300 minutes; p < 0.01), likely reflecting docking time and the learning curve involved.

Rates of temporary stoma creation, bowel/ureter/nerve/vessel injury, and other complications were similar.

Median hospital stay was 7 days for the robotic group and 6 days for the laparoscopic group (p = 0.1).

Anastomotic leak rates (6.45% vs 5%; p = 0.9) and chyle leak rates (2.8% vs 2.1%; p = 0.9) were also comparable between the groups and

overall Clavien-Dindo complication rates did not differ significantly (20.9% vs 17.5%respectively).

There was also no difference in margin positivity-distal (1.8% vs 2.6%; p = 0.6) or circumferential (5.5% vs 2.9%; p = 0.4)-between both the groups.

Conclusion/Discussion: Inter-sphincteric resection for low rectal cancer remains technically demanding, irrespective of the surgical approach. Although the robotic platform offers improved ergonomics and visualization, these advantages did not translate into superior short-term outcomes in this study. In high-volume centers with good surgical expertise, both robotic and laparoscopic approaches appear to yield comparable perioperative results.