EP626 - Surgical outcomes of laparoscopic versus robotic total mesorectal excision for rectal cancers at a tertiary centre

Purpose/Background: Colorectal cancer is the third most common cancer with rectal cancer accounting for more than 30% of the cases. Surgery remains the main curative option for rectal cancer cases with total mesorectal excision (TME) being the standard approach. Over the years minimally invasive techniques have gained popularity and studies have showed their feasibility in experienced hands. The aim of this study was to compare the surgical outcomes of laparoscopic versus robotic TME for rectal cancers.

Methods/Interventions: Records of patients undergoing laparoscopic or robotic TME between January 2013 and February 2025 were analysed. Both the groups were compared with respect to surgical outcomes, recurrences and disease free survival using SPSS v25 statistical analysis.

Results/Outcomes: Out of total 1833 patients (mean age 49.7 yrs), 1579 patients (86.1%) underwent laparoscopic TME while 254 (13.9%) underwent robotic TME. Rectal cancer case stage I to IV were included. Majority of cases were males (64.3%) and lower rectal cancers (54.9%). 46 patients (2.5%) were operated post neoadjuvant chemotherapy only, 1560 patients (85%) [85% in laparoscopic and 84% in robotic] received pre operative radiation with/without chemotherapy and 213 patients were operated upfront (11.6%). Sphincter preserving TME was done in 1242 patients (67.8%) [67% in laparoscopic and 72% in robotic] and pelvic lymph node dissection was done in 60 (3.3%) cases [3% in laparoscopic and 5.1% in robotic]. Median BMI was significantly higher in robotic cases (23.7 vs 22.9 kg/m2) and also higher in the intersphincteric resection group. Low anterior resection was the most commonly done procedure (47.6% cases). On histopathology, T3/T4 cases accounted for 58.8% (59% in laparoscopic and 57% in robotic) cases and 15.9% (16% in laparoscopic and 15% in robotic) were node positive with predominant histopathology being non mucinous adenocarcinoma (87.2%). Laparoscopic cases had fewer high grade complications (Clavien Dindo 3 or above) [8.2% vs 13.4%, p=0.011], less re-explorations (3.9 % vs 7.9%, p=0.008), less CRM positive rate (0.9 % vs 2.8%, p=0.032) as compared to robotic TME. There were more conversions in robotic group (6.7% vs 2.9%, p=0.004). Laparoscopic cases had less anastomotic leak (2.4% vs 3.5%, p=0.395) but it was not statistically significant. Both groups had comparable blood loss, hospital stay (7-8 days), 3 year recurrence rates (11.3 % in laparoscopic and 11.8% in robotic, p=0.885) and mortality rates (1.8% in laparoscopic vs 0.8% in robotic, p=0.377). Three year disease free survival (DFS) was 75.9% and 77.4 % respectively (p=0.229) in laparoscopic and robotic groups.

Conclusion/Discussion: This retrospective study showed that the laparoscopic approach had better short term surgical outcomes as compared to robotic TME but long term outcomes were comparable in both the groups.

Disease free survival laparoscopic versus robotic TME