A decade with robot-assisted surgery : How far have we come? A study comparing surgical outcomes in rectal cancer

Abstract: Introduction: In recent years, robot-assisted surgery has taken over as a first option in rectal cancer treatment. The overall perception is that robot-assisted surgery is a method with good surgical outcomes. Many current studies have focused on comparing robot-assisted surgery to conventional laparoscopy. To our knowledge, few studies have been conducted to compare surgical outcomes in rectal cancer over time in robot-assisted surgery as training and knowledge increases in the field. Aim: To examine the two most commonly used robot-assisted surgical procedures in rectal cancer, to compare surgical outcomes of each procedure over a ten-year period. Method: A retrospective comparative study design was used. The national Swedish Colorectal Cancer Registry (SCRCR) was used to identify patients who underwent robot-assisted rectal cancer surgery at Örebro University Hospital between 2013 and 2022. Two surgical procedures were assessed: anterior resection and abdomino-perineal resection. Studied outcomes included: console-time, operation time, blood loss, hospital stay and conversion rate. Group comparisons were performed. Results: In total 202 patients were included and grouped into two periods (2013-2017; 2018-2022). A statistically significant reduction was observed in both procedures regarding blood loss in the later period. No other statistically significant differences were identified. Patients operated with APR in the later period were less fit. Conclusion: The surgical procedures showed comparable clinical outcomes in both periods. Our study showed that more complex cases in the group operated with APR were selected in the second period, which could imply that a higher degree of surgical proficiency was obtained over time.